Anti-coagulants-induced intracranial hemorrhage managed with decompressive craniectomy: a case report of lesson learned

Introduction and Importance: Intracerebral hemorrhage (ICH)secondary to use of anti-coagulants is one of the fearsome complications. Hemorrhage within the intracranial space due to such anti-coagulants results in expansion of the intracranial bleeding despite the reversal of anti-coagulants. Hence timely surgical intervention can be lifesaving. Case Summary: An elderly female who was undergoing management for her deranged coagulation parameters was found to be in a state of features suggestive of stroke. Patient was on regular anti-coagulants medication for her cardiology issues. CT scan showed intracranial hemorrhage which underwent expansion in same day hence decompressive craniectomy was done. In further stay in the ICU patient GCS was fluctuating but symptomatic improvement was noted. Anti-coagulants adjustment was done from cardiologist and further there was no expansion of intracranial bleeding with within normal coagulation parameters. Discussion: Anti-coagulants are rampantly used in several cases . Despite the several complications there is desperate need of such medications for the betterment of the patient condition. Pharmacological management is major modality in reversal of OAC induced ICH but in rare cases in the background of OACs induced ICH there occurs expansion of hemorrhage. Hence the need for neurosurgical intervention whether be it minimal invasive surgery or decompressive craniectomy . Conclusion: In the background of less prevalence of OACs induced ICH, there is absence of robust guiding treatment protocol. Furthermore there exist minimal reported cases which underwent surgical intervention and resulted good prognosis.