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Spontaneous spinal epidural hematoma in a patient with a mechanical aortic valve taking warfarin
M Maingi1, M F Glynn, H E Scully
1Department of Medicine, University of Toronto, Ontario.
Abstract:
A 59-year-old male with a mechanical aortic valve taking warfarin presented to hospital with Brown-Séquard syndrome caused by a spontaneous spinal epidural hematoma (SSEH) precipitated by a coughing fit. Guided by a literature review of the risks of administering or withholding anticoagulation in this patient, doctors advised a regimen of warfarin to achieve an international normalized ratio of 1.5 to 2 and dipyridamole (75 mg qid) to protect against thromboembolic complications while minimizing the risk of recurrent SSEH.
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