Intracerebral Haemorrhage, Prosthetic Heart Valve and Anticoagulation

Shah, N; Dawson, Suzanne L.

doi:10.1177/014107680409700311

Cited by 3 publications

(1 citation statement)

References 5 publications

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“…Our primary literature search yielded 4136 articles, of which 809 abstracts were selected for review. Of those, 223 full‐length articles were screened and data were extracted from 57 studies that fulfilled our inclusion and exclusion criteria [3–59]. The secondary search strategy identified an additional 80 abstracts and eventually data were extracted from six additional studies [60–65].…”

Section: Resultsmentioning

confidence: 99%

Management of anticoagulation following central nervous system hemorrhage in patients with high thromboembolic risk

Hawryluk

Austin

Furlan

et al. 2010

Journal of Thrombosis and Haemostasis

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To cite this article: Hawryluk GWJ, Austin JW, Furlan JC, Lee JB, OÕKelly C, Fehlings MG. Management of anticoagulation following central nervous system hemorrhage in patients with high thromboembolic risk. J Thromb Haemost 2010; 8: 1500-8. Summary. Background:Patients who present with central nervous system (CNS) hemorrhage while on anticoagulation (AC) for thromboembolic (TE) risk factors are a challenge to manage. Objective: We sought to inform decisions surrounding the timing and intensity of AC resumption by performing a systematic review. Methods: Three reviewers screened publications from Medline and EMBASE and extracted data. Hemorrhagic and TE adverse events that occurred subsequent to the index hemorrhage were recorded, as was their timing relative to presentation and covariates that might influence their occurrence. Results: Data were extracted from 63 publications detailing 492 patients; 7.7% of patients experienced hemorrhagic complications and 6.1% experienced TE complications. Hemorrhagic complications were more common within 72 h of presentation while TE complications were more common thereafter. Patients restarted on AC after 72 h were significantly more likely to have a TE complication (P = 0.006) and those restarted before 72 h were more likely to hemorrhage (P = 0.0727). Factors associated with rehemorrhage included younger age, traumatic cause, subdural hematomas and failure to reverse AC. TE complications were more common in younger patients and those with spinal hemorrhage, multiple hemorrhages, and non-traumatic causes of the index hemorrhage. Re-initiation of AC at a lower intensity also significantly increased the risk of TE complications. Interpretation: Our results suggest that it may be prudent to re-initiate AC earlier than previously thought, with the timing and intensity modified based on predictors of TE and hemorrhagic complications. These findings must be explored in a prospective study because of limitations inherent to the analyzed studies.

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Section: Resultsmentioning

confidence: 99%

Management of anticoagulation following central nervous system hemorrhage in patients with high thromboembolic risk

Hawryluk

Austin

Furlan

et al. 2010

Journal of Thrombosis and Haemostasis

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Dilemmas in Managing Intracerebral Haemorrhage and Thromboembolism

Fuller

Dudley

Maule³

et al. 2004

J R Soc Med

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Letters to the Editor

Chikwe

Ovens

2004

J R Soc Med

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Firstly, the terminology used in their article needs clarification. The valve in their case report is presumably mechanical, as it is described as 'bileaflet' and the references cited apply to mechanical valves only. The term 'metallic valve', used in the comment section, is best avoided since most mechanical valves are nowadays largely ceramic.Secondly, although we agree that there is not a large amount of guidance on the management of intracranial bleeds in patients with mechanical valves, there are some useful papers specifically addressing this subject. In a review of the published work Crawley et al. 2 recommend full reversal of the coagulopathy with vitamin K and fresh frozen plasma, or with a prothrombin complex concentrate containing factors VII, II, IX and X. They identify the first 24 hours after an intracranial bleed as the most important time for correcting coagulopathy, since 50% of bleeds in anticoagulated patients continue to evolve over this time period, compared with only 10% of bleeds in nonanticoagulated patients. They conclude that the decision whether to restart warfarin should be based on the patient's risk of thromboembolism (which they calculate at 0.016% per day) versus the risk of further intracranial bleeding. Wijdicks et al. 3 followed up 39 patients with mechanical heart valves who had their anticoagulation reversed after intracranial haemorrhage. No patient experienced an embolic event during reversal, or a further intracranial bleed after reintroduction of oral anticoagulants during the hospital period. These workers conclude that oral anticoagulation should be discontinued for 1 to 2 weeks in these patients, if there is no previous evidence of systemic embolization. Joanna Chikwe Lauren Ovens

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Intracerebral Haemorrhage, Prosthetic Heart Valve and Anticoagulation

Cited by 3 publications

References 5 publications

Management of anticoagulation following central nervous system hemorrhage in patients with high thromboembolic risk

Management of anticoagulation following central nervous system hemorrhage in patients with high thromboembolic risk

Dilemmas in Managing Intracerebral Haemorrhage and Thromboembolism

Letters to the Editor

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