Introduction: Guideline recommendations for resumption of anticoagulation following intracranial hemorrhage are at least four weeks after stable bleed. However, most recommendations are specific to nonvalvular etiologies and do not address mechanical valves. Mechanical valves are at high risk of valve thrombosis, which carries high mortality and morbidity. We sought to review our experience of resuming anticoagulation in mechanical valve patients three days after stable head CT.
Methods: Retrospective review of patients admitted to the Neurocritical Care Unit with mechanical valve and hemorrhagic event from January 2013 through present. Most patients were started on low dose heparin drip three days after stable head CT. The incidence of hematoma expansion or new hemorrhage was recorded.
Results: 28 patients were identified: 17 patients with aortic valves, 9 with mitral, and 2 with both valve types. Subdural hematoma (SDH) was the most common admission diagnosis, followed by intracerebral hemorrhage (ICH). All but three patients had anticoagulation reversed upon admission. Anticoagulation was restarted an average of 2.7 days following stable head CT. Two patients had expanding hemorrhage, both of which had hypertensive episodes in the hours leading up to neurological decline. One patient had an EVD tract hemorrhage. Average time from anticoagulation to complication was 2.7 days. No thrombotic complications were noted.
Conclusions: Resumption of heparin three days after stable head CT is generally safe and effective in intracranial hemorrhage patients at high embolic risk due to mechanical heart valves. Our patient population had relatively low hemorrhagic complications and no thrombotic complications.
Patient Care: Provide guidance on resumption of anticoagulation in intracerebral hemorrhage patients with mechanical heart valves.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Understand the thromboembolic risks associated with mechanical heart valves 2.) Understand current stroke guidelines on anticoagulation resumption.