What is the clinical evidence from this study?

Study design: Case Report. Population: Atrial Fibrillation (n=1). Intervention: Apixaban vs. Vitamin K antagonists. Primary outcome: Incidence of Pulmonary Embolism after interruption of anticoagulant therapy.

What question did this study set out to answer?

To explore the management of oral anticoagulant therapy in an elderly patient with atrial fibrillation and pulmonary embolism post-subdural hematoma.

February 2, 2026Open Access

Case report: Regarding the 2018 European heart rhythm association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation

Key Result

The patient developed pulmonary embolism after interruption of anticoagulant therapy post intra-cranial bleeding and was treated successfully with apixaban.

Key Points

To explore the management of oral anticoagulant therapy in an elderly patient with atrial fibrillation and pulmonary embolism post-subdural hematoma.
Presented a case of an 82-year-old female with permanent atrial fibrillation
Monitored CHA2DS2-VASc score of 4 and renal function (creatinine clearance 32 ml/min)
Administered unfractionated heparin followed by enoxaparin and later apixaban after 7 days
Patient exhibited traumatic subdural hematoma and subsequent pulmonary embolism
Oral anticoagulation was halted after surgery but was indicated due to acute PE
Apixaban was determined to be the optimal choice for balancing bleeding risk and thrombosis prevention

Study Design

Type

Case Report (n=1)

Structured PICO

Population

1 female patient, 82 years old, with permanent atrial fibrillation, recent traumatic subdural hematoma, and acute pulmonary embolism.

Intervention

Unfractionated heparin followed by enoxaparin 40 mg sc twice daily, then apixaban 5 mg BID.

This case report highlights the application of guidelines for individualized anticoagulant therapy in a complex clinical scenario involving atrial fibrillation, pulmonary embolism, and recent major bleeding.

Limitations

This is a single case report and findings may not be generalizable.
Limited quantitative data on treatment outcomes.

Abstract

A female 82-year old patient is presented with permanent atrial fibrillation on vitamin K antagonist, who developed traumatic subdural hematoma, which was treated with surgically drainage and who developed pulmonary embolism as a complication. Oral anticoagulant therapy was interrupted after intervention and did not returned, and as a consequence she developed pulmonary embolism (PE), after two months. At admission to our hospital she was decompensated, with high heart rate and relatively small thrombus burden in the pulmonary tree. Since her CHA2DS2-VASc score was 4 and she had acute PE, she had two indications for oral anticoagulant therapy. On the other side, patient had 82 years, recent subdural hematoma, creatinine clearance 32 ml/min and low body mass index 17 kg/m2. Treatment of PE was started with unfractionated heparin and continue with enoxaparin 40 mg sc twice daily. After seven days oral anticoagulation with apixaban 5 mg BID was applied as a drug with the best balance between thrombosis prevention and bleeding. Conclusion. Complex clinical scenarios in patients with AF and PE are very often presented in the real-world praxis. The guidelines for the use of anticoagulant therapy in those patients are the base for the decision of the choice, dose and duration of anticoagulant therapy adjusted to patient characteristics.

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