The following is a summary of “Timing of Anticoagulation Resumption and Risk of Ischemic and Hemorrhagic Complications in Patients With ICH and Mechanical Heart Valves,” published in the August 2024 issue of Neurology by Sakusic et al.
Researchers conducted a retrospective study examining the association between reversal therapy and ischemic stroke, duration of anticoagulation and thromboembolic risk, and timing of anticoagulation resumption and rebleeding or intracranial hemorrhage (ICH) expansion risk.
They studied adult patients with mechanical heart valves who were admitted for ICH (January 1, 2000, and July 13, 2022) across 3 tertiary hospitals. The primary endpoints included thromboembolic events (cerebral, retinal, or systemic) while off anticoagulation and ICH expansion after resuming anticoagulation (defined as a one-third increase in intracerebral hematoma volume, a one-third increase in convexity subdural hemorrhage diameter, or visibly clear expansion of other ICH sites).
The results showed 171 patients with mechanical heart valves who had ICH. Reversal therapy for anticoagulation was administered to 79.5% of the patients. No increased risk of thromboembolic complications was observed in those who received anticoagulation reversal. Time off anticoagulation did not correlate with ischemic stroke risk. Only 2 patients had a stroke within 7 days of ICH, both with additional major thromboembolism risk factors. The incidence of ischemic stroke/transient ischemic attack while off anticoagulation was 6.4%, lower than the 9.9% rate of ICH expansion after resuming anticoagulation. Additionally, mortality was higher in patients with ICH expansion (41%) compared to those with ischemic stroke off anticoagulation (9%). Intravenous heparin bridging with warfarin resumption was strongly linked to a higher risk of ICH expansion than restarting warfarin alone.
Investigators concluded that withholding anticoagulation for at least 7 days post-ICH might be safe in patients with mechanical heart valves, while heparin bridging during anticoagulation resumption could increase bleeding risk.
Source: neurology.org/doi/10.1212/WNL.0000000000209664
The post Anticoagulation Management and Outcomes in Mechanical Heart Valve Patients with ICH first appeared on Physician's Weekly.