1 / 11

Anticoagulation Management After Intracranial Hemorrhage in Patients with Prosthetic Valves

This analysis examines the complications of anticoagulation in patients with prosthetic valves following an intracranial hemorrhage (ICH). It highlights the risks associated with untreated valve thrombosis (1.8% per patient-year), mechanical valve embolism (4% per patient-year), and the significant elevation in ICH risk (7-10 fold, 0.3-1% per year). The mortality rate from anticoagulant-related ICH is approximately 60%. Guidelines suggest careful timing for restarting anticoagulation therapy after ICH, balancing thromboembolic risk against potential recurrence of bleeding.

roderick-jake
Télécharger la présentation

Anticoagulation Management After Intracranial Hemorrhage in Patients with Prosthetic Valves

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Prosthetic Valve;Anticoagulation After ICH Dr.Tahsin.N

  2. Complications A meta-analysis in 1994 - not anticoagulated • Prosthetic valve thrombosis - 1.8% per patient-year (95% CI 0.9–3.0%). • Mechanical valve embolism resulting in death, stroke or peripheral ischaemia requiring surgery 4% per patient-year (95% CI 2.9–5.2%). This is reduced to 2.2% by antiplatelet drugs and 1.0% per patient-year with warfarin. • Risk of ICH increased by 7–10 fold, to an absolute risk of 0.3–1% per year. The mortality associated with oral anticoagulant related ICH is about 60% • The risk of ICH recurrence - 2% to 4% per patient-year.

  3. Lobar hemorrhage or cerebral amyloidangiopathy - higher risk of anticoagulant related ICH recurrence than thromboembolic events – No anticoagulants. Deep hemispheric ICH/ hypertension that can be well controlled and high risk of thromboembolism – Anticoagulation

  4. Risk factors - Recurrent bleed • Amyloidangiopathy – Lobar haemorrrhage (4% Vs 2%) • The presence and number of microbleeds on T2-wted gradient-echo MRI • Apolipoprotein E genotype58 • High Blood pressure • High INR

  5. Timing The European Stroke Initiative :patients with a strong indication for anticoagulation should be restarted on warfarin after 10 to 14 days, depending on the risk of thromboembolism and ICH recurrence. The American Heart Association : patients with a very high risk of thromboembolism for whom restarting warfarin is considered, warfarin may be restarted 7 to 10 days after ICH onset. The American College of Chest Physicians : start prophylactic dose heparin the day after an ICH - no clear guidance on restarting warfarin.

  6. THANK YOU

More Related