The Relationship of Subdural Hematoma to Anticoagulant Therapy

At the present time, hypoprothrombinemia induced by anticoagulant drugs is the most commonly encountered coagulation defect in medical practice.¹The extensive use of anticoagulants in the treatment of thromboembolic and cardiovascular disorders has been accompanied by reports of neurological complications including subarachnoid bleeding, intracerebral hemorrhage, intraspinal hemorrhage, and subdural hematoma.²⁻⁹Although subdural hematoma has been reported least frequently, this study suggests that it occurs more often in relation to anticoagulant therapy than has been realized. As early as 1944, Shleven and Lederer¹⁰presented a patient with uncontrollable hemorrhage after therapy with bishydroxycoumarin who at autopsy was found to have a subdural hematoma in addition to extensive bleeding in other parts of the body. Nathanson, Cravioto, and Cohen¹¹in 1958 discussed the development of subdural hematomas in 3 patients receiving anticoagulant therapy. Wells and Urrea¹²found subdural hematomas in 5 patients out of a group of