Anticoagulation is essential for patients with mechanical heart valves; however, its management in peri operative period could be a dilemma. Frequently, bridging therapy is applied in this situation to prevent thromboembolic events. The risk and benefit of this strategy is not completely clarified. Furthermore, it become more complex if haemorrhagic complication was associated especially intracerebral localization. In lacking of data supporting a specific treatment strategy, The management of these patients often poses a significant challenge to balance between providing increasing bleeding events and providing ischemic complication. We report a case report of using bridging therapy in patient with mechanical valve in periprocedural cardiac resynchronization surgery complicated by hemorrhagic cerebral hematoma, through which we will discuss the therapeutic modalities of this patients in the light of studies and consensus of learned societies.

Schönlein-Henoch purpura is a non-thrombocytopenic systemic vasculitis of small-caliber vessels due to immune complexes. We report the case of an adult 30 year old man admitted for a generalized edematous syndrome with purpuric lesions in the 2 lower limbs revealing a dilated cardiomyopathy whose etiological assessment was in favor of a Schönlein-Henoch purpura with cardiac, renal, dermatological involvement. The diagnosis was difficult to establish given the clinical polymorphism. Also, management was complicated given the multifocal involvement. The treatment was based on corticosteroid therapy and rituximab but the evolution was, unfortunately, not satisfactory.