Do you think the treatment given for my father is right?

Question

Hi doctor,

My father, who is 58 years old, having diabetes for the last 23 years. He always takes Insulin and other sugar tablets. His weight is 147.71 Pounds and height is 5 feet 5 inches. For the last two months, he has been taking Aspirin 75 mg. He had a minor headache for the last few days. Also, he had a cold and cough and took Azithromycin. Six days back, some blood came out through cough and he was advised to stop Aspirin. So, he did not take Aspirin for the last five days. Yesterday, he felt nauseous and vomited continuously. He had blurred vision, felt an imbalance while standing and had severe headaches. Then, he had a CT (Computed Tomography) scan and a subdural blood clot was found. CT scan report summary NCCT (Non Contrast Computed Tomography) of the brain suggests subacute on chronic subdural hemorrhage in right cerebral convexity with mass effect. So, our neurosurgeon suggests for operation, but due to Aspirin he kept the operation on hold for four to five days. But, my father is still unconscious. He is in ICU (Intensive Care Unit) and under observation. But, in this condition, is it right decision to keep the operation on hold? In this condition, can we move the patient by flight to another place for better treatment?

Answer 1

Hi,

Welcome to icliniq.com.

First of all, let me tell you that the decision to hold the operation is correct. Everywhere in the world, that is the standard practice. We do not operate for at least five days after stopping the Aspirin or Clopidogrel. Aspirin and Clopidogrel are basically sorts of blood thinners, and they prevent clotting. During surgery, clotting of blood is very important. If it does not clot and continues to bleed, surgery will not be successful.

We do the same practice. We keep the patient under observation if the patient is sick and operate after five days. If the patient is not very sick, we discharge them and call them back after five days. Regarding the transfer, he has subacute on chronic hematoma, and he is unconscious, so the transfer would be very risky.

Even minor trauma to his head or pressure change in flight during transfer can create major problems. While he is under observation, if he deteriorates further, then doctors will operate in spite of Aspirin and we do the same. But while transferring, if he deteriorates, then we cannot do anything. So, from my point of view, it is better that he continues there.

I hope this helps.