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J Neurol Neurosurg Psychiatry 2000;69:396-398 ( September )

Lesson of the month

Management of intracranial bleeding associated with anticoagulation: balancing the risk of further bleeding against thromboembolism from prosthetic heart valves Francesca Crawleya, David Bevanb, Damian Wrena

a Department of Neurology, Atkinson Morley's Hospital, Copse Hill London SW20, UK, b Department of Haematology, St George's Hospital Medical School, London, UK

Correspondence to: Dr Damian Wren

Received 7 April 2000; Accepted 20 April 2000

Mechanical heart valves are associated with a risk of thromboembolism and anticoagulation is generally recommended. However, this is inevitably associated with a risk of intracranial bleeding. The case of a patient who sustained an intracranial bleed while taking warfarin for a prosthetic aortic valve and a further two intracranial bleeds while on heparin as an inpatient is discussed and the literature on the management of intracranial haemorrhage in patients on warfarin with prosthetic valves is reviewed.


Keywords: prosthetic heart valves; intracranial haemorrhage; heparin; warfarin

© 2000 by Journal of Neurology, Neurosurgery, and Psychiatry


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