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Warfarin Reinitiation After Intracranial Hemorrhage: A Case Series of Heart Valve Patients

  • Andrea Wan (a1), Ken Butcher (a2) (a3), Mathew Hodgson (a4), Karen Schultz (a4) and Tammy J. Bungard (a5)...

Abstract:

Patients with mechanical heart valves are at high thrombotic risk and require warfarin. Among those developing intracranial hemorrhage, limited data are available to guide clinicians with antithrombotic reinitiation. This 13-patient case series of warfarin-associated intracranial hemorrhages found the time to reinitiate antithrombotic therapy (17 days, interquartile range 21.5 days), and changes to international normalized ratio targets were variable and neither correlated with the type, location, or etiology of bleed, nor the valve and associated thromboembolic risk. The initial presentation significantly impacted prognosis, and diligent assessment and follow-up may support positive long-term outcomes.

RÉSUMÉ:

Procurer une deuxième dose de warfarine à la suite d’une hémorragie intracrânienne : une étude de série de cas chez des patients à qui l’on a installé des valves cardiaques mécaniques. Les patients à qui l’on a installé une telle valve demeurent à risque élevé de thrombose et nécessite qu’on leur administre de la warfarine. Du côté de ceux ayant été victimes d’une hémorragie intracrânienne, peu de données sont disponibles afin d’orienter les cliniciens en ce qui concerne un traitement subséquent aux anti-thrombotiques. Cette étude de série de cas incluant 13 patients à qui l’on a administré de la warfarine à la suite d’une hémorragie intracrânienne a été en mesure de se baser sur un second traitement anti-thrombotique (17 jours ; EI 21,5 jours). Les changements par rapport aux cibles de rapport international normalisé (RIN) ont été variables et n’ont pas pu être corrélés au type, à l’emplacement ou à l’étiologie des saignements pas plus qu’au risque associé à la valve ou au risque thromboembolique. Chose certaine, cette étude initiale a eu un impact certain sur l’appréciation de l’évolution ultérieure de ces patients. En cela, il se pourrait qu’une évaluation et un suivi diligents puissent favoriser l’évolution à long terme de leur état de santé.

Copyright

Corresponding author

Correspondence to: Dr. Tammy J. Bungard, Division of Cardiology, Department of Medicine, University of Alberta, 362 Heritage Medical Research Centre, Edmonton, AlbertaT6G 2S2, Canada. Phone: 780-492-3431. Email: tammy.bungard@ualberta.ca

References

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Keywords

Warfarin Reinitiation After Intracranial Hemorrhage: A Case Series of Heart Valve Patients

  • Andrea Wan (a1), Ken Butcher (a2) (a3), Mathew Hodgson (a4), Karen Schultz (a4) and Tammy J. Bungard (a5)...

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