As anesthesiologists, intensivists, and surgeons in a quaternary academic medical center, we often find ourselves in situations where life-altering decisions need to be made in a complex environment with incomplete and rapidly changing information. In our estimation, this has never been truer than with the patient being discussed herein.

Patients on anticoagulants are at greater risk of acute intracranial bleeding, a neurosurgical emergency that benefits from immediate attention. While relatively uncommon, a patient who presents with an acute or evolving intracranial hemorrhage is traditionally transferred to the closest OR for immediate evacuation, regardless of whether the patient is at home, on the medical ward, or in the ICU. In this article, we highlight a recent debate on whether a 35-year-old female with peripartum cardiomyopathy, anticoagulated for right and left ventricular assist devices (VAD) who presented with acute intracranial bleeding while in the ICU, should have been operated on at the...

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