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Examining the Duration and Safety of Withholding Anticoagulation After an Intracerebral Hemorrhage in Patients With Mechanical Heart Valves

      Mechanical heart valves have an increased risk of thromboembolic and bleeding events owing to the life-long need for anticoagulation. The estimated incidence of thromboembolic events ranges from 0.3% to 1.3%/year and bleeding events 0.34% to 1.8%/patient-year.
      • Cannegieter SC
      • Rosendaal FR
      • Briët E.
      Thromboembolic and bleeding complications in patients with mechanical heart valve prostheses.
      ,
      • Dürrleman N
      • Pellerin M
      • Bouchard D
      • Hébert Y
      • Cartier R
      • Perrault LP
      • Basmadjian A
      • Carrier M.
      Prosthetic valve thrombosis: twenty-year experience at the Montreal Heart Institute.
      Intracerebral hemorrhage (ICH) is a potentially catastrophic neurologic event with an incidence of 0.5%/patient-years.
      • Panduranga P
      • Al-Mukhaini M
      • Al-Muslahi M
      • Haque MA
      • Shehab A
      Management dilemmas in patients with mechanical heart valves and warfarin-induced major bleeding.
      Current guidelines do not provide definitive recommendations on a safe duration to withhold anticoagulation in patients with mechanical valves after ICH, and there are limited data with a wide range of 3 to 21 days.
      • Flint AC
      • Lingamneni R
      • Rao VA
      • Chan SL
      • Ren X
      • Pombra J
      • Hemphill 3rd, JC
      • Bonow RO.
      Risks of thrombosis and rehemorrhage during early management of intracranial hemorrhage in patients With mechanical heart valves.
      ,
      • Kuramatsu JB
      • Sembill JA
      • Gerner ST
      • Sprügel MI
      • Hagen M
      • Roeder SS
      • Endres M
      • Haeusler KG
      • Sobesky J
      • Schurig J
      • Zweynert S
      • Bauer M
      • Vajkoczy P
      • Ringleb PA
      • Purrucker J
      • Rizos T
      • Volkmann J
      • Müllges W
      • Kraft P
      • Schubert AL
      • Erbguth F
      • Nueckel M
      • Schellinger PD
      • Glahn J
      • Knappe UJ
      • Fink GR
      • Dohmen C
      • Stetefeld H
      • Fisse AL
      • Minnerup J
      • Hagemann G
      • Rakers F
      • Reichmann H
      • Schneider H
      • Wöpking S
      • Ludolph AC
      • Stösser S
      • Neugebauer H
      • Röther J
      • Michels P
      • Schwarz M
      • Reimann G
      • Bäzner H
      • Schwert H
      • Claßen J
      • Michalski D
      • Grau A
      • Palm F
      • Urbanek C
      • Wöhrle JC
      • Alshammari F
      • Horn M
      • Bahner D
      • Witte OW
      • Günther A
      • Hamann GF
      • Lücking H
      • Dörfler A
      • Achenbach S
      • Schwab S
      • Huttner HB.
      Management of therapeutic anticoagulation in patients with intracerebral haemorrhage and mechanical heart valves.
      Additionally, there are little data on long-term thromboembolic or hemorrhagic complications in these patients.
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      References

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        Thromboembolic and bleeding complications in patients with mechanical heart valve prostheses.
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        Prosthetic valve thrombosis: twenty-year experience at the Montreal Heart Institute.
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        Management dilemmas in patients with mechanical heart valves and warfarin-induced major bleeding.
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        • Bonow RO.
        Risks of thrombosis and rehemorrhage during early management of intracranial hemorrhage in patients With mechanical heart valves.
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        • Sembill JA
        • Gerner ST
        • Sprügel MI
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        • Roeder SS
        • Endres M
        • Haeusler KG
        • Sobesky J
        • Schurig J
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        • Fisse AL
        • Minnerup J
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        • Neugebauer H
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        Management of therapeutic anticoagulation in patients with intracerebral haemorrhage and mechanical heart valves.
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