Timing of anticoagulant re-initiation following intracerebral hemorrhage in mechanical heart valves: Survey of neurosurgeons and thrombosis experts

Fahad AlKherayf, Yan Xu, Harrison Westwick, Ioana Doina Moldovan, Philip S. Wells

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Background While oral anticoagulation (OAC) is universally indicated for patients with mechanical heart valves (MHVs), OAC resumption following anticoagulant-associated intracerebral hemorrhage (ICH) is an area of uncertainty. We sought to determine the practice preferences of North American neurosurgeons and thrombosis experts on optimal timing of OAC re-initiation. Methods A cross-sectional survey was disseminated to North American members of the American Association of Neurological Surgeons and the International Society for Thrombosis and Haemostasis. Demographic factors, as well as a clinical scenario with 14 modifiable clinical risk factors were included in the survey. Results 504 physicians completed our survey (response rate 34.3%). Majority of participants were affiliated with academic centres, and managed ≤ 10 ICH patients with MHV per year. There was wide distribution in response in optimal timing for OAC resumption following an ICH: 59% and 60% preferred to re-start OAC between 3 and 14 days following the hemorrhagic event (median of 6–7 days). Smaller hemorrhages (<30 cm2). CHADS2 score ≥2, concomitant venous thromboembolism, mitral valve prosthesis, caged-ball valves and multiple valves prompted earlier OAC resumption. Conclusion Wide variation in the current practice of neurosurgeons and thrombosis specialists exist when they encounter patients with ICH and MHV, though decisions were influenced by patient- and valve-related factors. As our observed variation likely reflects the immense gap in current evidence, prospective randomized trials in this population are therefore urgently needed.

Original languageEnglish
Pages (from-to)23-27
Number of pages5
JournalClinical Neurology and Neurosurgery
Volume154
DOIs
StatePublished - 1 Mar 2017
Externally publishedYes

Keywords

  • Anticoagulant
  • Intracerebral hemorrhage
  • Mechanical heart valves
  • Subdural hematoma
  • Survey

Fingerprint

Dive into the research topics of 'Timing of anticoagulant re-initiation following intracerebral hemorrhage in mechanical heart valves: Survey of neurosurgeons and thrombosis experts'. Together they form a unique fingerprint.

Cite this