Oral anticoagulant therapy in patients with mechanical heart valve and intracranial haemorrhage

Erica Romualdi; Evy Micieli; Walter Ageno; Alessandro Squizzato

doi:10.1160/TH08-07-0474

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2009; 101(02): 290-297
DOI: 10.1160/TH08-07-0474

Review Article

Schattauer GmbH

Oral anticoagulant therapy in patients with mechanical heart valve and intracranial haemorrhage

A systematic review

Authors

Erica Romualdi

¹Department of Clinical Medicine, University of Insubria, Varese, Italy
Evy Micieli

¹Department of Clinical Medicine, University of Insubria, Varese, Italy
Walter Ageno

¹Department of Clinical Medicine, University of Insubria, Varese, Italy
Alessandro Squizzato

¹Department of Clinical Medicine, University of Insubria, Varese, Italy

Abstract

Summary

Optimal timing for restarting anticoagulant therapy after intracranial bleeding is a critical issue. The purpose of this systematic review is to summarize published studies on the management of oral anticoagulant therapy after intracranial bleeding secondary to the use of vitamin K antagonists in patients with a mechanical heart valve. A computer-assisted search of the MEDLINE and EMBASE electronic databases till January 2008 was performed. Two investigators independently performed study selection and completed a predefined quality assessment and data extraction form. Main inclusion criterion was the enrolment of patients with a mechanical heart valve and intracranial haemorrhage during oral anticoagulant treatment. Any randomised controlled trial, observational cohort study, case series and reports was included. No randomised controlled trials were identified. Six observational cohort studies were included in the final analysis. All studies were of low quality. A total of 120 patients were enrolled. Anticoagulation was restarted within a broad time range (2 days to 3 months). Four ischaemic strokes and two recurrent cerebral haemorrhages occurred after anticoagulation was restarted after a mean follow-up of 7.9 months. Eighteen patients were described in the selected case reports. Anticoagulant therapy was restarted within four days to eight weeks. Two patients had a recurrent haemorrhagic event, and no ischaemic events were reported. In conclusion, restarting oral anticoagulant therapy few days and, indirectly, stopping anticoagulant therapy for a few days (even for 7–14 days) after the occurrence of cerebral haemorrhage are both safe. However, well-designed studies are strongly recommended to provide better evidence.

Keywords

Anticoagulant - cerebral bleeding - mechanical heart valve

Volltext

Referenzen

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