Examining the Duration and Safety of Withholding Anticoagulation After an Intracerebral Hemorrhage in Patients With Mechanical Heart Valves

Abstract

Mechanical heart valves have an increased risk of thromboembolic and bleeding events owing to the life-long need for anticoagulation. The estimated incidence of thromboembolic events ranges from 0.3% to 1.3%/year and bleeding events 0.34% to 1.8%/patient-year. 1 Cannegieter SC Rosendaal FR Briët E. Thromboembolic and bleeding complications in patients with mechanical heart valve prostheses. Circulation. 1994; 89: 635-641 Crossref PubMed Scopus (906) Google Scholar ,2 Dürrleman N Pellerin M Bouchard D Hébert Y Cartier R Perrault LP Basmadjian A Carrier M. Prosthetic valve thrombosis: twenty-year experience at the Montreal Heart Institute. J Thorac Cardiovasc Surg. 2004; 127: 1388-1392 Abstract Full Text Full Text PDF PubMed Scopus (104) Google Scholar Intracerebral hemorrhage (ICH) is a potentially catastrophic neurologic event with an incidence of 0.5%/patient-years. 3 Panduranga P Al-Mukhaini M Al-Muslahi M Haque MA Shehab A Management dilemmas in patients with mechanical heart valves and warfarin-induced major bleeding. World J Cardiol. 2012; 4: 54-59 Crossref PubMed Google Scholar Current guidelines do not provide definitive recommendations on a safe duration to withhold anticoagulation in patients with mechanical valves after ICH, and there are limited data with a wide range of 3 to 21 days. 4 Flint AC Lingamneni R Rao VA Chan SL Ren X Pombra J Hemphill 3rd, JC Bonow RO. Risks of thrombosis and rehemorrhage during early management of intracranial hemorrhage in patients With mechanical heart valves. J Am Coll Cardiol. 2015; 66: 1738-1739 Crossref PubMed Scopus (5) Google Scholar ,5 Kuramatsu JB Sembill JA Gerner ST Sprügel MI Hagen M Roeder SS Endres M Haeusler KG Sobesky J Schurig J Zweynert S Bauer M Vajkoczy P Ringleb PA Purrucker J Rizos T Volkmann J Müllges W Kraft P Schubert AL Erbguth F Nueckel M Schellinger PD Glahn J Knappe UJ Fink GR Dohmen C Stetefeld H Fisse AL Minnerup J Hagemann G Rakers F Reichmann H Schneider H Wöpking S Ludolph AC Stösser S Neugebauer H Röther J Michels P Schwarz M Reimann G Bäzner H Schwert H Claßen J Michalski D Grau A Palm F Urbanek C Wöhrle JC Alshammari F Horn M Bahner D Witte OW Günther A Hamann GF Lücking H Dörfler A Achenbach S Schwab S Huttner HB. Management of therapeutic anticoagulation in patients with intracerebral haemorrhage and mechanical heart valves. Eur Heart J. 2018; 39: 1709-1723 Crossref PubMed Scopus (45) Google Scholar Additionally, there are little data on long-term thromboembolic or hemorrhagic complications in these patients.