Pat. with prosthetic heart valve on warfarin and developed ich. when and whow we return anticoagulant?

The risk of : Hemorrhage complications in the above setting is 1% per year. If ich occur the anticiagulation have to be reverse and most probably the clot evacuated. When to restart is controversial depending on the prosthetic valve(mitral vs aortic), atrial fibrillation, enlarge atrial chamber and systolic ventricular dysfunction. Each case is different but up to 14 days may be safe. Neuro and cardiac follow.

Anticoagulation: This is a more complex issue than what can be covered here. An intracerebral hemorrhage while on warfarin is an emergency, and reversal of the anticoagulant is essential. Restarting anticoagulant for prosthetic valve protection can only be done when the neurosurgeon is confident that the bleeding in the brain has been adequately stopped and the risk for re-bleeding has been controlled.