title: Intracerebral hemorrhage in patients after heart valve replacement.
abstract: BACKGROUND
  Although prevention of hematoma enlargement and thromboembolic complications is critically important in acute intracerebral hemorrhage (ICH) patients with prosthetic heart valves, clinical data are scarce. The goal of this study was to elucidate patient characteristics, acute treatments, and the clinical course of them.
  
  
  METHODS
  We investigated a retrospective cohort of consecutive acute ICH patients with prosthetic heart valves. Neurological data, hospital management, hemorrhagic and thromboembolic complications and functional disability/mortality were reviewed.
  
  
  RESULTS
  We identified 38 patients (27 men; 67.9±16.7 years). The median ICH volume was 22.8 ml. The most frequent location was lobar (50%). All patients with mechanical valves (25/25) and 46% of patients with bioprosthetic valves (6/13) were receiving warfarin at the time of hospital admission. The median anticoagulation withholding period was 2 days in 24 patients who ultimately resumed anticoagulation. Hematoma enlargement within 24 h was observed in eight patients and hemorrhagic complications occurred in three patients. Thromboembolic stroke occurred in four patients. At discharge, death had occurred or severe disability was present in 53% of patients (20/38).
  
  
  CONCLUSIONS
  Hematoma enlargement, hemorrhagic complications or thromboembolic stroke occurred in a significant number of patients during hospitalization. ICH was a serious complication among patients with valve replacement.
authors.affiliation: Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Japan.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Nishimura
authors.affiliation: Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Japan. Electronic address: koga@ncvc.go.jp.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Koga
authors.affiliation: Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Minematsu
authors.affiliation: Department of Neurosurgery, National Cerebral and Cardiovascular Center, Japan.
authors.forename: Jun C
authors.initials: JC
authors.lastname: Takahashi
authors.affiliation: Department of Neurology, National Cerebral and Cardiovascular Center, Japan.
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Nagatsuka
authors.affiliation: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Japan.
authors.forename: Junjiro
authors.initials: J
authors.lastname: Kobayashi
authors.affiliation: Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Toyoda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000209:etiology*; D015331:Cohort Studies; D016208:Databases, Factual / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology*; D012189:Retrospective Studies; D013923:Thromboembolism / Q000175:diagnosis / Q000209:etiology
keywords: Anticoagulation; Heart valve replacement; Infective endocarditis; Intracerebral hemorrhage; Thromboembolic complication; Warfarin