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

 

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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.

• References

• 1 Cannegieter SC, Rosendaal FR, Briet E. Thromboembolic and bleeding complications in patients with mechanical heart valve prostheses. Circulation 1994; 89: 635-641.
  CrossrefPubMedGoogle Scholar
• 2 Hart RG, Tonarelli SB, Pearce LA. Avoiding central nervous system bleeding during antithrombotic therapy: recent data and ideas. Stroke 2005; 36: 1588-1593.
  CrossrefPubMedGoogle Scholar
• 3 Cannegieter SC, Rosendaal FR, Wintzen AR. et al. Optimal oral anticoagulant therapy in patients with mechanical heart valves. New Engl J Med 1995; 333: 11-17.
  CrossrefPubMedGoogle Scholar
• 4 Kearon C, Kahn SR, Agnelli G. et al. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133: 454S-545S.
  CrossrefPubMedGoogle Scholar
• 5 Jadad AR, Moore RA, Jenkinson C. et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Control Clin Trials 1996; 17: 1-12.
  CrossrefPubMedGoogle Scholar
• 6 Meta-analysis of Observational Studies in Epidemiology (MOOSE) group.. Meta-analysis of observational studies in epidemiology: a proposal for reporting. J Am Med Assoc 2000; 283: 2008-2012.
  CrossrefPubMedGoogle Scholar
• 7 Araki Y, Tajima K, Shimomura T. et al. A case report on mitral valve replacement associated with anti-phospholipid syndrome in systemic lupus erythematosus. Kyobu Geka 1997; 50: 480-482.
  PubMedGoogle Scholar
• 8 Asai Y, Sugiki K, Abe T. et al. Surgical experience of subacute subdural hematoma occurring during the anticoagulant therapy. Rinsho Kyobu Geka 1984; 4: 87-91.
  PubMedGoogle Scholar
• 9 Brueck M, Hoppe M, Kramer W. Fatal thrombosis of mechanical mitral valve prosthesis. Med Klin 2003; 98: 151-152.
  CrossrefPubMedGoogle Scholar
• 10 Hinata S, Hiekata T, Kamata S. et al. Subarachnoid hemorrhage following commencement of danazol treatment in a patient well controlled on warfarin anticoagulation. Kyobu Geka 1991; 44: 555-557.
  PubMedGoogle Scholar
• 11 Iwaniukowicz A, Kowianski P, Beldzinski P. et al. Para-cerebral hematomas caused by coagulopathies. Pol Merkur Lekarski 1997; 2: 283-284.
  PubMedGoogle Scholar
• 12 Kasahara S, Sakai A, Isomatsa Y. et al. Subdural hematoma complicated after open heart surgery: a report of two cases with successful treatment. Kyobu Geka 1994; 47: 732-735.
  PubMedGoogle Scholar
• 13 Kienast J, Ringelstein EB, Borggrefe M. Are there guidelines for timing readministration of anticoagulation with marcumar in patients with artificial heart valves after intracerebral hemorrhage (stroke, subarachnoid hemorrhage, subdural hematoma)?. Internist (Berl) 1997; 38: 83-85.
  PubMedGoogle Scholar
• 14 Motomochi M, Makita Y, Nabeshima S. Spinal subarachnoid hemorrhage due to a thoracic neurinoma during anticoagulation therapy. A case report. Neurol Med -Chir 1981; 21: 781-784.
  CrossrefPubMedGoogle Scholar
• 15 Nobuoka W, Konishi M, Asazuma S. et al. A case of chronic subdural hematoma developing during long-term anticoagulant drug therapy after mitral valve replacement. Rinsho Kyobu Geka 1984; 4: 603-605.
  PubMedGoogle Scholar
• 16 Rusznak M. Experience in the care of patients with artificial heart valves. Orv Hetil 1991; 132: 2199-2202.
  PubMedGoogle Scholar
• 17 Toyonaga M, Hagiwara N, Irie F. et al. Acute cervical spinal epidural hematoma during antithrombotic therapy: dual warnings against antithrombotic therapy. Rinsho Shinkeigaku 2003; 43: 287-290.
  PubMedGoogle Scholar
• 18 Al-Ahmad AM, Hartnett-Daudelin D, Salem DN. Antithrombotic therapy for prosthetic valves: routine treatment and special considerations. Curr Cardiol Rep 2001; 3: 85-89.
  CrossrefPubMedGoogle Scholar
• 19 Alpert JS. How can we improve our use of oral anticoagulants?. Am J Med 2006; 119: 101-102.
  CrossrefPubMedGoogle Scholar
• 20 Anandaraja S, Kothari SS, Bahl VK. Oral anticoagulation therapy for prosthetic valves. Indian Heart J 2004; 56: 281-285.
  PubMedGoogle Scholar
• 21 Badaoui R, Koukougnon M, El kC. et al. Spontaneous spinal hemorrhage complicating anticoagulant therapy. Can J Anaesth 2003; 50: 750-751.
  CrossrefPubMedGoogle Scholar
• 22 Benavides PH, Gorodezky M, Hurtado del Rio D. Anticoagulant therapy in patients with the Starr-Edwards prosthesis. Arch Inst Cardiol Mex 1968; 38: 198-203.
  PubMedGoogle Scholar
• 23 Bjork VO, Henze A. Management of thromboembolism after aortic valve replacement with the BjorkShiley tilting disc valve. Medicamental prevention with dicumarol in comparison with dipyridamole – acetylsalicylic acid. Surgical treatment of prosthetic thrombosis. Scand J Thorac Cardiovasc Surg 1975; 9: 183-191.
  PubMedGoogle Scholar
• 24 Bonow RO, Carabello BA, Chatterjee K. et al. ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease). J Am Coll Cardiol 2006; 48: e1-e148.
  CrossrefPubMedGoogle Scholar
• 25 Halperin JL, Fry SJ, Houser SL. Weekly clinico-pathological exercises. New Engl J Med 1999; 341: 1829-1835.
  CrossrefPubMedGoogle Scholar
• 26 Caird J, Chukwunyerenwa C, Ali Z. et al. Craniotomy with prosthetic heart valves: A clinical dilemma. Br J Neurosurg 2006; 20: 40-42.
  CrossrefPubMedGoogle Scholar
• 27 Chen YC, Hong TC, Hou CJY. Transesophageal echocardiography in the detection of prosthetic mitral valve thrombosis caused by inadequate anticoagulation. J Med Ultrasound 2003; 11: 111-114.
  CrossrefPubMedGoogle Scholar
• 28 Chikwe J, Ovens L. Dilemmas in managing intracerebral haemorrhage and thromboembolism. J R Soc Med 2004; 97: 309.
  PubMedGoogle Scholar
• 29 Chung CK. Serial magnetic resonance imaging findings for a spontaneously resolving spinal subdural hematoma: case report. Neurosurgery 1998; 43: 1495.
  PubMedGoogle Scholar
• 30 Dale J, Myhre E, Loew D. Bleeding during acetylsalicylic acid and anticoagulant therapy in patients with reduced platelet reactivity after aortic valve replacement. Am Heart J 1980; 99: 746-752.
  CrossrefPubMedGoogle Scholar
• 31 Dentali F, Ageno W, Crowther M. Treatment of cou-marin-associated coagulopathy: A systematic review and proposed treatment algorithms. J Thromb Haemost 2006; 4: 1853-1863.
  CrossrefPubMedGoogle Scholar
• 32 Ellison J, Thomson AJ, Walker ID. et al. Use of enoxaparin in a pregnant woman with a mechanical heart valve prosthesis. Br J Obstet Gynaecol 2001; 108: 757-759.
  PubMedGoogle Scholar
• 33 Fannin TF, Gray WJ. Anticoagulant drugs in the eldery. Br Med J 1989; 298: 184.
  PubMedGoogle Scholar
• 34 Ferrera PC, Bartfield JM. Outcomes of anticoagulated trauma patients. Am J Emerg Med 1999; 17: 154-156.
  CrossrefPubMedGoogle Scholar
• 35 Fuller R, Dudley NJ, Maule J. et al. Dilemmas in managing intracerebral haemorrhage and thromboembolism. J R Soc Med 2004; 97: 308-309.
  CrossrefPubMedGoogle Scholar
• 36 Gruber EM, Seitelberger R, Mares P. et al. Ventricular thrombus and subarachnoid bleeding during support with ventricular assist devices. Ann Thorac Surg 1999; 67: 1778-1780.
  CrossrefPubMedGoogle Scholar
• 37 Guly HR, Jones LO, Nokes TJC. Trauma in the anticoagulated patient. Trauma (GBR) 2005; 7: 155-161.
  CrossrefPubMedGoogle Scholar
• 38 Henderson RD, Walker DG, Mitchell K. et al. More than one dilemma. Neurocrit Care 2004; 1: 375-378.
  CrossrefPubMedGoogle Scholar
• 39 Hoffman O, Montalescot G, Thomas D. Warfarin and prosthetic heart valves. Sang Thromb Vaiss 1993; 5: 403-410.
  PubMedGoogle Scholar
• 40 Hurst PG, Seeger J, Carter P. et al. Value of magnetic resonance imaging for diagnosis of cervical epidural hematoma associated with anticoagulation after cardiac valve replacement. Am J Cardiol 1989; 63: 1016-1017.
  CrossrefPubMedGoogle Scholar
• 41 Isom OW, Williams CD, Falk EA. et al. Evaluation of anticoagulant therapy in cloth-covered prosthetic valves. Circulation 1973; 48: III48-III50.
  PubMedGoogle Scholar
• 42 Kanter R, Kanter M, Kirsch W. et al. Spontaneous posterior fossa subdural hematoma as a complication of anticoagulation. Neurosurgery 1984; 15: 241-242.
  CrossrefPubMedGoogle Scholar
• 43 Lagares A, Dominguez J, Lobato RD. et al. Bilateral posterior fossa subdural haematomas secondary to anticoagulant therapy. Acta Neurochir (Wien ) 1998; 140: 1097-1098.
  CrossrefPubMedGoogle Scholar
• 44 Lankiewicz MW, Hays J, Friedman KD. et al. Urgent reversal of warfarin with prothrombin complex concentrate. J Thromb Haemost 2006; 4: 967-970.
  CrossrefPubMedGoogle Scholar
• 45 Lieberman A, Hass WK, Pinto R. Intracranial hemorrhage and infarction in anticoagulated patients with prosthetic heart valves. Stroke 1978; 9: 18-24.
  CrossrefPubMedGoogle Scholar
• 46 Lin J, Hanigan WC, Tarantino M. et al. The use of recombinant activated factor VII to reverse warfarin-induced anticoagulation in patients with hemorrhages in the central nervous system: preliminary findings. J Neurosurg 2003; 98: 737-740.
  CrossrefPubMedGoogle Scholar
• 47 Little CP, Patel N, Nagaria J. et al. Use of topically applied rt-PA in the evacuation of extensive acute spinal subdural haematoma. Eur Spine J 2004; 13: 380-383.
  PubMedGoogle Scholar
• 48 Lopez AE, Barnard JJ, White CL. et al. Motor-vehicle collision-related death due to delayed-onset subarachnoid hemorrhage associated with anticoagulant therapy. J Forensic Sci 2004; 49: 807-808.
  PubMedGoogle Scholar
• 49 Maeda K, Gotoh H, Chikui E. et al. Intratumoral hemorrhage from a posterior fossa tumor after cardiac valve surgery--case report. Neurol Med Chir (Tokyo) 2001; 41: 548-550.
  CrossrefPubMedGoogle Scholar
• 50 McNaughton H, Barber PA, Gommans J. et al. Management problems of spontaneous ICH. Hosp Med 2005; 66: 229-234.
  PubMedGoogle Scholar
• 51 Petrasko MS, Sadaniantz A. Bleeding and thrombotic risks for prosthetic heart valves: A review of the principles of management. Cardiovasc Rev Rep 2000; 21: 475-480.
  PubMedGoogle Scholar
• 52 Phan TG, Wijdicks EF. Management of intracranial bleeding associated with anticoagulation: balancing the risk of further bleeding against thromboembolism from prosthetic heart valves. J Neurol Neurosurg Psychiatry 2001; 70: 820-821.
  CrossrefPubMedGoogle Scholar
• 53 Russell N, Maroun FB, Jacob JC. Spinal subdural hematoma in association with anticoagulant therapy. Can J Neurol Sci 1981; 8: 87-89.
  CrossrefPubMedGoogle Scholar
• 54 Shah N, Dawson SL. Intracerebral haemorrhage, prosthetic heart valve and anticoagulation. J R Soc Med 2004; 97: 129-130.
  CrossrefPubMedGoogle Scholar
• 55 Sharma N, Grover A, Radotra BD. Prosthetic cardiac valve replacement: Management problems. Asian Cardiovasc Thorac Ann 1998; 6: 179-182.
  CrossrefPubMedGoogle Scholar
• 56 Stein PD. Antithrombotic therapy in valvular heart disease. Clin Geriatr Med 2001; 17: 163-172.
  CrossrefPubMedGoogle Scholar
• 57 Stollberger C, Finsterer J, Langer T. et al. Problems, interventions and complications in Long-Term oral anticoagulant therapy. J Thromb Trombolysis 2002; 14: 65-72.
  PubMedGoogle Scholar
• 58 Talalak P, Chotmonggol V, Bhakeecheep S. et al. Long term oral anticoagulant therapy after heart valve prostheses at Siriraj Hospital. J Med Assoc Thailand 1989; 72: 250-255.
  PubMedGoogle Scholar
• 59 Veshchev I, Elran H, Salame K. Recombinant coagulation factor VIIa for rapid preoperative correction of warfarin-related coagulopathy in patients with acute subdural hematoma. Med Sci Monit 2002; 8: CS98-100.
  PubMedGoogle Scholar
• 60 Wijdicks EF, Schievink WI, Brown RD. et al. Early anticoagulation in patients with prosthetic heart valves and intracerebral hematoma. Neurology 1999; 52: 676-677.
  PubMedGoogle Scholar
• 61 Wilson WR, Geraci JE, Danielson GK. Anticoagulant therapy and central nervous system complications in patients with prosthetic valve endocarditis. Circulation 1978; 57: 1004-1007.
  CrossrefPubMedGoogle Scholar
• 62 Wong JB, Webb RK, Pauker SG. Double trouble: a patient with two prosthetic valves and two episodes of intracranial bleeding. Med Decis Making 1987; 7: 174-193.
  CrossrefPubMedGoogle Scholar
• 63 Kawamata T, Takeshita M, Kubo O. et al. Management of intracranial hemorrhage associated with anticoagulant therapy. Surg Neurol 1995; 44: 438-443.
  CrossrefPubMedGoogle Scholar
• 64 Anderson TJ, Donaldson IM. Successful treatment of subdural haematoma during antuicoagulant treatment. Br Med J 1989; 299: 1566.
  PubMedGoogle Scholar
• 65 Bagga R, Sawhney H, Saxena SV. et al. Intracranial bleed in a pregnant patient on oral anticoagulants for prosthetic heart valve. Acta Obstet Gynecol Scand 2001; 80: 766-767.
  CrossrefPubMedGoogle Scholar
• 66 Barra JA, Kretz JG, Grondin P. Sub-dural hematoma, complication of anti-coagulants for valvular mechanical prostheses. Role of heterografts. Ann Cardiol Angeiol 1979; 28: 163-165.
  PubMedGoogle Scholar
• 67 Conti S, La TD, Gambelunghe G. et al. Successful treatment with rFVIIa of spontaneous intracerebral hemorrhage in a patient with mechanical prosthetic heart valves. Clin Lab Haematol 2005; 27: 283-285.
  CrossrefPubMedGoogle Scholar
• 68 Crawley F, Bevan D, Wren D. Management of intracranial bleeding associated with anticoagulation: Balancing the risk of further bleeding against thromboembolism from prosthetic heart valves. J Neurol Neurosurg Psychiatry 2000; 69: 396-398.
  CrossrefPubMedGoogle Scholar
• 69 Gomez CR, Sandhu J, Mehta P. Resumption of anticoagulation during hypertensive cerebral hemorrhage with prosthetic heart valve. Stroke 1988; 19: 407.
  PubMedGoogle Scholar
• 70 Jain AK, Lal V, Sharma YP. et al. Low molecular weight heparin in management of intracerebellar hemorrhage in patient with mitral and aortic prosthetic valves. Neurol India 2002; 50: 373-374.
  PubMedGoogle Scholar
• 71 Maingi M, Glynn MF, Scully HE. et al. Spontaneous spinal epidural hematoma in a patient with a mechanical aortic valve taking warfarin. Can J Cardiol 1995; 11: 429-432.
  PubMedGoogle Scholar
• 72 Munoz Morente A, Baron Ramos MA, Mateos Fernandez S. et al. Anticoagulation with Bemiparina after intracerebral hemorrhage as complication of bacterial endocarditis on metallic prosthetic valve. An Med Interna 2004; 21: 551-553.
  PubMedGoogle Scholar
• 73 Nagano N, Tabata H, Hashimoto K. Anticoagulant-related intracerebral hemorrhage in patients with prosthetic heart valves. Report of two cases. Neurol Med -Chir 1991; 31: 743-745.
  CrossrefPubMedGoogle Scholar
• 74 Nakagawa T, Kubota T, Handa Y. et al. Intracranial hemorrhage due to long-term anticoagulant therapy in patients with prosthetic heart valves. Four case reports. Neurol Med-Chir 1995; 35: 156-159.
  PubMedGoogle Scholar
• 75 Park S, Kase CS. Re-anticoagulation after warfarin-related intracerebral hemorrhage in patients with mechanical heart valves: The clinical dilemma. Semin Cerebrovasc Dis Stroke 2006; 5: 221-224.
  PubMedGoogle Scholar
• 76 Telerman-Toppet N, Moerman C, Noterman J. Spontaneous spinal epidural hematoma, unusual complication of anticoagulant treatment. Acta Neurol Belg 1972; 72: 118-129.
  PubMedGoogle Scholar
• 77 Ananthasubramaniam K, Beattie JN, Rosman HS. et al. How safely and for how long can warfarin therapy be withheld in prosthetic heart valve patients hospitalized with a major hemorrhage?. Chest 2001; 119: 478-484.
  CrossrefPubMedGoogle Scholar
• 78 Butler AC, Tait RC. Restarting anticoagulation in prosthetic heart valve patients after intracranial haemorrhage: a 2-year follow-up. Br J Haematol 1998; 103: 1064-1066.
  CrossrefPubMedGoogle Scholar
• 79 Phan TG, Koh M, Wijdicks EFM. Safety of discontinuation of anticoagulation in patients with intracranial hemorrhage at high thromboembolic risk. Arch Neurol 2000; 57: 1710-1713.
  CrossrefPubMedGoogle Scholar
• 80 Wijdicks EF, Schievink WI, Brown RD. et al. The dilemma of discontinuation of anticoagulation therapy for patients with intracranial hemorrhage and mechanical heart valves. Neurosurgery 1998; 42: 769-773.
  CrossrefPubMedGoogle Scholar
• 81 Leker RR, Abramsky O. Early anticoagulation in patients with prosthetic heart valves and intracerebral hematoma. Neurology 1998; 50: 1489-1491.
  CrossrefPubMedGoogle Scholar
• 82 Babikian VL, Kase CS, Pessin MS. et al. Resumption of anticoagulation after intracranial bleeding in patients with prosthetic heart valves. Stroke 1988; 19: 407-408.
  PubMedGoogle Scholar
• 83 Marietta M, Pedrazzi P, Girardis M. et al. Intracerebral haemorrhage: an often neglected medical emergency. Int Emerg Med 2007; 2: 38-45.
  CrossrefPubMedGoogle Scholar
• 84 Qureshi AI, Tuhrim S, Broderick JP. et al. Spontaneous intracerebral hemorrhage. New Engl J Med 2001; 344: 1450-1460.
  CrossrefPubMedGoogle Scholar
• 85 Rosand J, Eckman MH, Knudsen KA. et al. The effect of warfarin and intensity of anticoagulation on outcome of intracerebral hemorrhage. Arch Intern Med 2004; 164: 880-884.
  CrossrefPubMedGoogle Scholar
• 86 Ansell J, Hirsh J, Poller L. et al. The pharmacology and management of the vitamin K antagonists: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126: 204S-233S.
  CrossrefPubMedGoogle Scholar