Re-Anticoagulation after Warfarin-Related Intracerebral Hemorrhage in Patients with Mechanical Heart Valves: The Clinical Dilemma

Seminars in Cerebrovascular Diseases and Stroke Pub Date : 2005-09-01 DOI:10.1053/j.scds.2006.03.002

Soojin Park MD, Carlos S. Kase MD

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引用次数: 5

Abstract

A 53-year-old woman with a prosthetic heart valve developed a left occipital intracerebral hemorrhage (ICH) while on treatment with warfarin for thromboembolism prophylaxis. The international normalized ratio was 5.8. She presented with left occipital headache, right homonymous hemianopia, and fluent aphasia. The ICH expanded in the initial hours after onset but subsequently stabilized after treatment with vitamin K₁, fresh frozen plasma, and recombinant activated factor VII. Her hospital course was stable, and the clinical deficits gradually resolved (aphasia) or improved (right homonymous hemianopia) after hospital discharge. She had the warfarin treatment restarted after 8 days from ICH onset, without subsequent complications. The available data and recommendations on the issue of restarting warfarin anticoagulation after an episode of intracranial bleeding are reviewed.

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机械心脏瓣膜患者华法林相关性脑出血后再抗凝:临床困境

一个53岁的妇女与人工心脏瓣膜发展左枕骨脑出血(ICH)，而华法林治疗预防血栓栓塞。国际标准化比率为5.8。患者表现为左侧枕部头痛，右侧同义性偏视，流利性失语。脑出血在发病后数小时内扩大，但在维生素k1、新鲜冷冻血浆和重组活化因子VII治疗后稳定下来。患者病程稳定，出院后临床缺陷逐渐消失(失语)或改善(右侧同名性偏视)。颅内出血8天后重新开始华法林治疗，无后续并发症。回顾了颅内出血后重新启动华法林抗凝治疗的现有数据和建议。

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Seminars in Cerebrovascular Diseases and Stroke

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