Abstract
Aim Patients with mechanical heart valves and coexisting atrial fibrillation (AFib-MHV)
who suffer an intraparenchymal hemorrhage (IPH, defined as bleeding solely within
the brain parenchyma and/or ventricle) are at a high risk of thromboembolism without
anticoagulation. Data are lacking regarding the safety of early re-initiation of anticoagulation
in these patients.
Patients and Methods We performed a descriptive, single-institution retrospective analysis of patients
with AFib-MHV who suffered a non-traumatic, supratentorial IPH between July 2013 and
June 2017. We analyzed the patients and IPH characteristics, anticoagulation and antiplatelet
use, the occurrence of thrombotic and hemorrhage complications, and discharge disposition.
We described the timing of initiation of anticoagulation and outcomes after IPH while
in-patient.
Results Six patients with AFib-MHV suffered a spontaneous IPH. Four were initiated on anticoagulation
prior to discharge, of whom two were initiated within 3 days post-hemorrhage. These
patients suffered no bleeding complications and were discharged home with a modified
Rankin Scale of 1.
Conclusion Patients with AFib-MHV who suffer a spontaneous IPH are a rare population to study.
Further studies to guide the management of restarting anticoagulation in this select
population are warranted.
Keywords
anticoagulation - intracerebral hemorrhage - mechanical heart valve - atrial fibrillation
