Anticoagulation Therapy Following Embolic or Hemorrhagic Stroke in the Patient with a Mechanical Heart Valve
Assistant Clinical Professor, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Dulles 6, Philadelphia, PA 19104, USA
- *Corresponding Author:
- Jesse M. Raiten MD
Assistant Clinical Professor
Department of Anesthesiology and Critical Care
Perelman School of Medicine
University of Pennsylvania, 3400 Spruce Street
Dulles 6, Philadelphia, PA 19104, USA
E-mail: [email protected]
Received date: June 23, 2011; Accepted date: August 29, 2011; Published date: September 05, 2011
Citation: Raiten J (2011) Anticoagulation Therapy Following Embolic or Hemorrhagic Stroke in the Patient with a Mechanical Heart Valve. J Anesthe Clinic Res 2:160. doi: 10.4172/2155-6148.1000160
Copyright: © 2011 Raiten J. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Background: An estimated 95,000 heart valve replacements are performed annually in the United States. Prosthetic valves may be either mechanical or bioprosthetic in composition. Mechanical valves offer added durability but commit the patient to taking lifelong anticoagulant therapy. Maintaining therapeutic levels of anticoagulation may be challenging, and inadequate anticoagulation can lead to thromboembolic or hemorrhagic complications. When a patient with a mechanical valve suffers a stroke, management of anticoagulation becomes more controversial and complicated. This article reviews the available evidence and guidelines for management of systemic anticoagulation following stroke in patients with mechanical heart valves.
Methods: A review of the PubMed database for pertinent articles, using the keywords “mechanical heart valve”, “anticoagulation”, “cerebrovascular accident”, and “stroke”. The clinical guidelines offered by the American College of Cardiology, American Heart Association, and American Stroke Association were also reviewed.
Results: There are no definitive guidelines for the management of patients with mechanical heart valves who suffer a stroke. Most of the data is from small case series and retrospective reviews.
Conclusion: Based on the available data, anticoagulation should be resumed rapidly following thromboembolic stroke in patients with a mechanical heart valve, once the risk of hemorrhagic transformation has declined. In the setting of a hemorrhagic stroke, it also appears safe to resume anticoagulation relatively rapidly (after approximately one week), although the risks of further bleeding must be considered. In either case, holding anticoagulation after a stroke for a few days does not expose the patient to significantly increased risk of acute thrombosis.