Cite this post as:
Guest Author. EMCrit CQIR – The Conundrum of Reversing Anticoagulants for Mechanical Heart Valves in Intracranial Hemorrhage. EMCrit Blog. Published on July 4, 2018. Accessed on March 28th 2024. Available at [https://emcrit.org/emcrit/reversing-anticoagulants-mechanical-heart-valves/ ].
Financial Disclosures:
Dr. Scott Weingart, Course Director, reports no relevant financial relationships with ineligible companies.
This episode’s speaker(s), (listed above), report no relevant financial relationships with ineligible companies.
CME Review
Original Release: July 4, 2018
Date of Most Recent Review: Jan 1, 2022
Termination Date: Jan 1, 2025
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You don’t give anything for these four weeks? Not even low dose LMWH or so?
Ash misquoted the piece–that was the rec for non-high risk for thrombosis patients. Corrected above. Restart anticoag as soon as deemed safe by the team.
excellent and thank you, ms. ashley. perhaps a dumb question, but has it been definitively proven that giving PCC and vit K lead to improved outcomes (M and M)? or even smaller hemorrhage size at 12/24 hours? i certainly do give stat PCC, and vit. K for these patients, and well as any major bleeds on coumadin. (or on NOAC’s). In some cases, if my lab turn around time is 30-45 minutes for a PT/INR, i might give a stat dose of 1500 units of Kcentra (there was a lecturer, i think on emcrit?, who said that 1500 units reverses… Read more »
Tom, Thanks for your comments and questions. I followed up with Dr. Callum to try to provide the best evidence out there on the questions you are asking, especially related to the efficacy of PCC you inquire about. Per Dr. Callum, “there is no solid evidence that anything we do on the coagulation side improves outcomes, but that being said few of us would be so bold as to NOT reverse”. A German retrospective cohort study published in JAMA in 2015 (https://doi.org/10.1001/jama.2015.0846) looked at the question of hematoma enlargement in the setting of reversal for anticoagulated patients with ICH. Hematoma… Read more »
Thank you for bringing up this interesting and in clinical practice often very tricky question. I think what you may want to add is the site of the mechanical heart valve is of critical importance. Patients with prosthetic mitral valves and/or multiple replaced heart valves are far more prone to devastating adverse events in case of stopping anticoagulation than patients with a single mechanical aortic valve (Daniels et al. Thromb Res. 2009 Jul; 124(3):300-5. and Pandarunga et al. World J Cardiol. 2012 Mar 26; 4(3): 54–59.) The guidelines (2017 ESC/EACTS Guidelines for the management of valvular heart disease) also shortly… Read more »