Abstract
A 76-year-old patient, long-term followed-up in a vascular outpatient clinic, comes in October 2017 to consult a possibility of changing current anticoagulant therapy. Since 2006, he has been on warfarin for recurrent venous thromboembolism (VTE) - thromboses of deep and superficial veins of the legs, thrombosis of splanchnic veins, and, moreover, in 2015 atrial fibrillation was registered.
In the long term, we managed to keep the INR within the therapeutic range. In September 2017, he was examined for neurological symptoms and CT scan showed voluminous subacute subdural haematoma bilaterally.
Trepanation, haematoma evacuation and external drainage were performed. After the surgery, he was administered low-molecular-weight heparin at a lower prophylactic dose; the neurosurgeons recommended restarting warfarin in one week.
However, the patient is concerned about recurrence of severe bleeding. After discussion with the patient and his family, we chose dabigatran 110 mg bid for long-term anticoagulation treatment; known data on the efficacy of dabigatran in patients with atrial fibrillation as well as in secondary VTE prophylaxis, the reduction of the risk of intracranial haemorrhage compared to warfarin, and the existence of a specific antidote played a role in our decision-making.