A postoperative intracranial hemorrhage due to a vitamin K deficiency in treated severe subarachnoid hemorrhage patients: A report of two cases

The authors report 2 cases of a postoperative intracranial hemorrhage in treated severe subarachnoid hemorrhage (SAH) patients due to a vitamin K (VK) deficiency. These cases are described below. Case 1: The patient, a 48-year- old woman, was admitted to our hospital because of an SAH, and a neck clipping was soon performed after admission. On the 10th postoperative day, an epidural hematoma was found, and on the 17th postoperative day, a hemorrhagic infarction occurred. Case 2: The patient, a 39-year-old man, was admitted to our hospital because of an SAH, and a neck clipping was soon performed after admission. On the 14th postoperative day, an epidural hematoma was detected. The concentration of the serum VK during an evacuation of the hematoma was found to have markedly decreased, and a coagulation examination revealed that a VK deficiency had caused the postoperative hemorrhage. A subsequent administration of VK resolved the hemorrhagic complications in both patients. The VK deficiency in these cases may have been caused by an increased VK consumption due to the pre-DIC state after the SAH and the invasive surgery, and the supression of VK production by intestinal flora because of long term antibiotic medication. It thus has been speculated that in severe SAH patients, a VK deficiency may be the cause of a postoperative hemorrhagic complication.