Discontinuing oral anti-coagulants in a patient with a cardiac valve prosthesis after a traumatic intracranial hemorrhage

On a regular basis, patients suffering from an intracranial hemorrhage are seen in the emergency department. Some of these patients use oral anticoagulation, which in case of intracranial bleeding has to be corrected to prevent hematoma expansion. For patients who require anticoagulation for a strong indication, for example, due to a mechanical heart valve, this poses a dilemma. The goal of this case report and literature review is to aid in the decision-making process in cases where a decision whether or not (and for which duration) oral anticoagulation should be discontinued has to be made.