INTRODUCCIÓNLas complicaciones neurológicas en las EI izquierdas tienen una incidencia que puede alcanzar hasta un 40% (1). Las hemorragias intracerebrales, aunque poco frecuentes (< 5%), presentan una elevada mortalidad (60-80%) (2) y suelen deberse a la transformación hemorrágica de un infarto previo, sobre todo en aquellos pacientes que están previamente anticoagulados (3). El manejo de los pacientes con prótesis valvulares metálicas infectadas y hemorragia cerebral es complicado, ya que, la necesidad de mantener la anticoagulación para evitar la trombosis valvular pone en riesgo al paciente para nuevos episodios hemorrágicos cerebrales. Sin embargo, no existe un consenso en la literatura sobre cuál debe ser el manejo de estas situaciones. Exponemos el caso de un paciente con EI y hemorragia intracerebral en el que optamos por sustituir el Acenocumarol por heparina sódica y posteriormente por Bemiparina, una heparina de bajo peso molecular que puede ser administrada una vez al día, y que mantuvimos durante tres meses sin que evidenciáramos nuevos sangrados cerebrales ni trombosis valvular a través de ecocardiografía. No hemos encontrado ningún caso de similares características donde la HBPM haya sido usada por un período mayor a dos semanas.45 [0212-7199 (2004) 21: 11; pp 551-553] ANALES DE MEDICINA INTERNA

Background: Endovascular therapies(EVT) have exponentially increased in the last few years. To maximize the benefits of EVT, complications related to the treatment need to be prevented or minimized with early detection and appropriate management. We implemented a specific registry to collect femoral post-puncture complications detected at different timepoints. Our aim was to identify factors associated with severe groin punction complications. Methods: Prospective study of consecutive patients treated with acute EVT or scheduled (angioplasty), admitted to our Stroke Unit from February2017-June2018. Post-catheterization femoral complications included: groin bleeding(GB), groin hematoma(GH), retroperitoneal hematoma(RH), femoral artery pseudoaneurysm(FAP), and artery dissection(AD). A specific registry was created for data collection at different timepoints: During or immediate post-EVT, at 24h post-compression and at discharge. Results: 384patients were treated with EVT(73%acute), mean age 71+/-13y.o, 69% men. Mynxgrip closure system was used in 346(91,8%). Compressive measures needed to be reinforced in 55 cases(14,5%)/changed in 15(4%). Early mobilization protocol(24-48h) was initiated in 335patients(92,3%). 9patients (2,8%) did not maintain the first 24h absolute rest. 57patients(15,1%) presented mild immediate complications(49GH,6GB). At 24h, 181(47,1%)patients presented GH(28,6%superficial, 18,2%internal) and 5GB(1,3%). At discharge, 29(8,1%)patients had presented clinically significant femoral complications: 16GH(13deep), 5FAP, 1AD, 4RH. 2 of those complications were fatal. Variables associated with severe complications at discharge were: age(p=0.037), non-use of mynxgrip(p=0.001), compressive replacement(p<0.001), non-compliance of early mobilization protocol(p=0.014). Conclusion: In our series, we found a yield of 8,1% of clinically significant groin complications associated with the EVT (0,5% fatal). We indentified age, closure device, requirement to replace compressive and lack of accomplishment of the early mobilization protocol as predictors of these complications.