Anticoagulation for postoperative
venous thromboembolism (VTE) may infer a higher risk of
intracranial hemorrhage. We treat patients with VTE using slowly titrating intravenous
heparin drip without bolus. When PTT is greater than 60 s, a head CT is obtained to monitor for the development of a
intracranial hemorrhage before transition to oral anticoagulation. We evaluated the utility of routine surveillance head CT to monitor for
intracranial hemorrhage during anticoagulation. This is a case series of neurosurgical patients in an academic quaternary hospital who developed a VTE after cranial procedures between 2007 and 2017. Over 11,000 patients were screened for the study. Patients' demographics data, surgical indication, PTT at the time of surveillance CT head, surveillance CT head findings, and patient's
clinical course were reviewed. A total of 83 patients were included. Three patients (3.6%) developed a new subclinical
hemorrhage on CT head imaging while on
heparin drip. Interval CT head showed stable
hemorrhage in all patients.
Heparin drip was stopped in two patients and they both progressed from DVT to
pulmonary embolism: one patient died due to
cardiac arrest, the other patient was transitioned to oral anticoagulation. In the third patient
heparin drip was continued uneventfully and transitioned to oral anticoagulation with no further clinical sequalae. Surveillance CT while on
heparin drip for VTE management detected subclinical
intracranial hemorrhage in a small subset of patients. Patients whose anticoagulation was stopped had progression of VTE. Undertreatment of VTE in the presence of subclinical
hemorrhage may lead to significant morbidity and mortality.