Valve replacement has saved hundreds of thousands of patients over the decades, and more and more patients are returning to normal work and life after valve replacement surgery. However, lifelong oral warfarin is required for anticoagulation after mechanical valve surgery, mainly to prevent prosthetic mechanical valve thrombosis, which has led to valve failure and dislodged embolism. However, bleeding and embolism due to improper anticoagulation are the most common complications after valve replacement, of which intracranial hemorrhage history is the most dangerous and serious, with an incidence of approximately 1%/patient-year, accounting for 10-12% of spontaneous cerebral hemorrhage and a morbidity and mortality rate that can exceed 50%. Diagnosis: For patients who are taking oral anticoagulants, intracranial hemorrhage must be highly suspected once symptoms such as unexplained severe headache, nausea, vomiting, impaired consciousness, hemiparesis, and hemianopia occur, while CT and MRI are required to confirm the diagnosis. Treatment: Time is life, because of its rapid development and high mortality within 24 hours, so once diagnosed, anticoagulants need to be stopped immediately and antagonistic drugs, such as vitamin K1, prothrombin complex, etc., should be applied, and most patients can recover normal coagulation function within a few hours. If the bleeding is heavy and neurological symptoms continue to worsen, neurosurgical support in the form of craniotomy or puncture and drainage will be required. When to start continued anticoagulation? After the bleeding stops, the patient must face the dilemma that not taking anticoagulants may lead to prosthetic valve failure, thrombus dislodgement and embolism, etc. Continuing anticoagulation may lead to intracranial bleeding again. How to balance the problem of intracranial hemorrhage and valve thrombosis? This problem is also troubling our physician comrades, and doctors at home and abroad have done a lot of research over the decades. One of them is Chandra from New Delhi, India.
Dr. D, who analyzed more than 80 relevant articles, the result is that the time to discontinue anticoagulation after intracranial hemorrhage is 7-14 days, and thereafter resume anticoagulation, so that the possibility of valve thrombosis and intracranial hemorrhage is very low. Intensity of anticoagulation: The probability of bleeding is much higher than the probability of embolism in Chinese people with anticoagulation, and the mortality and risk of intracranial hemorrhage is much higher than that of cerebral embolism due to thrombus. Therefore, it is recommended that Chinese people, especially the elderly, can use low-intensity anticoagulation, such as keeping the international normalized ratio INR at 1.5-2.0. One of my patients suffered an intracranial hemorrhage last month, but fortunately the bleeding was small. He was cured with conservative treatment, so I wish him well and I would like to give this document to all of you who have received valve replacement and are on anticoagulation therapy, and wish you good health!