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New recommended therapy for mechanical heart valves and intracerebral hemorrhage

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World’s largest study defines optimum time frame for administering anticoagulants

Patients with mechanical heart valves are given anticoagulant medication to protect them from typical complications such as strokes. However, up to now there have been no established recommendations about how to deal with this medication in the acute phase if intracerebral hemorrhage occurs due to the strong blood thinning effect of the medication. Experts from 22 hospitals have now drawn up a recommended therapy based on a study carried out across Germany.

We recommend restarting treatment for high-risk patients with anticoagulants a week after intracerebral hemorrhage has occurred.

says Prof. Dr. Hagen Huttner, Chief Consultant at the Department of Neurology who led the study. The results of the study were published today in the European Heart Journal.

Our study dealt with a genuine dilemma in intensive care medicine. On the one hand, patients with mechanical heart valves require strong blood thinning medication to prevent blood clots from forming, but on the other, if intracerebral hemorrhaging occurs, we need to stop giving this medication without really knowing when we can start giving it again. We finally have much clearer data for treating these patients thanks to this study.

says Prof. Dr. Dr. h.c. Stefan Schwab, Director of Neurology, who is also President of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI).
Experts from 22 university hospitals and full-service hospitals in Germany evaluated data from 2500 patients with intracerebral hemorrhage in the world’s largest study about the connection between anticoagulants and intracerebral hemorrhage in patients with mechanical heart valves. Out of these 2500, 166 patients with a mechanical heart valve suffered from brain hemorrhage whilst taking ‘Marcumar’.

During the study, researchers compared data from patients with a mechanical heart valve who were re-prescribed anticoagulants during their treatment (48 percent) with those who weren’t.

Within the first two weeks of treatment, a significantly higher risk of new complications with hemorrhaging with a frequency of almost 26 percent became apparent in the first group who were taking anticoagulants. However, the risk in the second group without anticoagulants was only around 6 percent.

says Hagen Huttner. The difference in the results between both groups was only minimal with regard to ischemic complications such as strokes caused by blood clots forming on the heart valve. Further analyses were added to this initial result by the researchers from Friedrich-Alexander-Universität Erlangen-Nürnberg led by Hagen Huttner and lead authors Dr. Joji Kuramatsu and Dr. Jochen Sembill.

During the second phase of the study, we used complex statistical methods to determine the time frame for recommencing treatment with anticoagulants. This means that the risk of bleeding is significantly higher up to almost two weeks after suffering from a brain hemorrhage. However, if you weigh up the risk of hemorrhage against the risk of blood clots forming, treatment with anticoagulants can restart in high-risk patients one week after a brain hemorrhage.

explains Hagen Huttner.

For Prof. Dr. Stephan Achenbach, Director of Department of Medicine 2 and co-author of the study, the results are groundbreaking for acute care and emergency medicine:

For the first time, we now have a solid set of findings for doctors that provides them with treatment recommendations for how to react when intracerebral hemorrhage occurs in patients who have mechanical heart valves and who are taking anticoagulants.

The results of the study have been published in the European Heart Journal.

Further information

Prof. Dr. Hagen Huttner
Phone: +49 9131 85-33001
hagen.huttner@uk-erlangen.de