So …. CT confirms a subdural bleed and the patient has recieved beriplex at a dose of 30 units/kg and vitamin K 2mg IV.  Initial INR was 2.6 and repeat INR 30mins following beriplex was 1.2.    Discussion with neurosurgeons follows, however they decide that the patient is not for surgical intervention.

The acute emergency has been addressed, however, now we must consider the further management of this patient.

You receive this patients hospital notes and discover he has a metallic mitral valve.

How do you proceed with the management of this patient?  Does anyone have any thoughts on anticoagulation for this patients?  When would you think about restarting anticoagulation, if at all?  Risks vs benefits?

Please reply on Twitter and always include #teamhaem to allow others to follow your comments. This case is designed particularly with non-haematologists in mind so please join in the debate and learn about haematological/oncological emergencies along the way. The case will continue to  evolve over the coming week so keep checking #teamhaem for more information.

Please note – all cases on Teamhaem are entirely fictional to protect patient confidentiality.