ArticleJournal of the American Heart Association2024
Optimal Timing for Resumption of Anticoagulation After Intracranial Hemorrhage in Patients With Mechanical Heart Valves.
Article in Journal of the American Heart Association, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.
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11 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Resumption of Warfarin After Intracranial Hemorrhage in Patients With Mechanical Heart Valves: A Systematic Review and Meta-Analysis.Journal of the American Heart Association · 2026Pooled it
- Timing and Safety of Anticoagulation Reinitiation After Intracranial Hemorrhage in Patients With Mechanical Valves: A Meta-Analysis.Neurology · 2025Pooled it
- Acute Type A Aortic Dissection with Concomitant Intracerebral Haemorrhage: A Therapeutic Dilemma Regarding the Timing of Surgery.Journal of cardiovascular development and disease · 2026Article
- Reinitiating anticoagulation in chronic subdural hematomas: does adding middle meningeal artery embolization add value? A multi-institutional, multinational database study.Journal of neurointerventional surgery · 2026Article
- Traumatic brain injury in patients with mechanical heart valves on lifelong anticoagulation: incidence, management, and outcomes of intracranial hemorrhage.Frontiers in cardiovascular medicine · 2026Article
- Recommencement of anti-thrombotics following traumatic intracranial haemorrhage; a preliminary survey of UK consultant neurosurgeons informing the RESTART-tICrH trial design.Brain & spine · 2026Article
- Early anticoagulant resumption after atypical intracerebral hemorrhage: beyond atrial fibrillation analysis of two clinical cases admitted to the University Hospital of Pisa.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025Article
- Multidisciplinary Expert Guidance for the Management of Severe Bleeding on Oral Anticoagulation: An Algorithm for Practicing Clinicians.Thrombosis and haemostasis · 2025Review
- Optimal Timing of Anticoagulation Initiation in Stroke Patients With Atrial Fibrillation: A Systematic Review.Cureus · 2025Review
- The safety and feasibility of anticoagulant resumption following middle meningeal artery embolization in patients with subacute subdural hematomas.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2025Article
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7 authors.
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Abstract
backgroundAnticoagulation in patients with intracranial hemorrhage (ICH) and mechanical heart valves is often held for risk of ICH expansion; however, there exists a competing risk of acute ischemic stroke (AIS). Optimal timing to resume anticoagulation remains uncertain. METHODS AND
resultsWe retrospectively studied patients with ICH and mechanical heart valves from 2000 to 2018. The primary outcome was a composite end point of symptomatic hematoma expansion or new ICH, AIS, and intracardiac thrombus up to 30 days post-ICH. The exposure was timing of reinitiation of anticoagulation classified as early (resumed up to 7 days after ICH), late (≥7 and up to 30 days after ICH), and never if not resumed or resumed after 30 days post-ICH. We included 184 patients with ICH and mechanical heart valves (65 anticoagulated early, 100 late, 19 not resumed by day 30 post-ICH). Twelve patients had AIS, 16 new ICH, and 6 intracardiac thromboses. The mean time from ICH to anticoagulation was 12.7 days. Composite outcomes occurred in 12 patients resumed early (18.5%), 14 resumed late (14.0%), and 4 never resumed (21.1%). There was no increased hazard of the composite outcome (hazard ratio [HR], 1.1 [95% CI, 0.2-6.0]), AIS, or worsening or new ICH among patients resumed early versus late. There was no difference in the composite among patients never resumed versus resumed. Patients who never resumed anticoagulation had significantly more severe ICH (median Glasgow Coma Scale: 10.6, 13.9, and 13.9 among those who resumed never, early, and late, respectively;
conclusionsIn this study of patients with ICH and mechanical heart valves, there was no difference in 30-day thrombotic and hemorrhagic brain-related outcomes when anticoagulation was resumed within 7 versus 7 to 30 days after ICH. Withholding anticoagulation >30 days was associated with severe baseline ICH, higher in-hospital case fatality, and elevated AIS risk.
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