A Case of COVID‑19 with Recent Surgery for Subdural Hematoma – A Therapeutic Thromboprophylaxis Dilemma



Department of Anaesthesiology and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India


Dear Sir,
The practice of preemptively administering therapeutic doses of 
low‑molecular‑weight heparin (LMWH) to prevent the dreaded 
complication of venous thromboembolism in COVID‑19 cases 
is practiced globally.[1,2] LMWH increases the chances of 
bleeding, but since COVID‑19 causes a relative prothrombotic 
state, it is needed to administer LMWH in such cases. Chronic 
subdural hematoma (cSDH) is one of the most common 
surgical interventions in daily neurosurgical procedures 
in which mortality and morbidity vary with urgency and 
postoperative complications. The risk of recurrent hematoma 
after cSDH is 5%–30% within a span of 2–3 months.[3] An 
anticoagulant drug like LMWH is a known risk factor for 
cSDH. The use of anticoagulants in severe COVID‑19 patients 
in postoperative cSDH is controversial. Here, we present a 
clinical dilemma to initiate LMWH in a patient suffering from 
severe COVID‑19 infection in postoperative cSDH surgery.

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