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 haemorrhage 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 haemorrhage has occurred’, says Prof. Dr. Hagen Huttner, Chief Consultant at the Department of Neurology at Universitätsklinikum Erlangen, 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’, says Prof. Stefan Schwab, Director of Neurology at Universitätsklinikum Erlangen, who is also President of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI). ‘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 haemorrhaging 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.’
Experts from 22 university hospitals and full-service hospitals in Germany evaluated data from 2500 patients with intracerebral haemorrhage in the world’s largest study about the connection between anticoagulants and intracerebral haemorrhage in patients with mechanical heart valves. Out of these 2500, 166 patients with a mechanical heart valve suffered from brain haemorrhage 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 haemorrhaging 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 Prof. Dr. Hagen Huttner, who led the study. The difference in the results between both groups was only minimal with regard to ischaemic 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 Prof. Dr. 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’, explains Prof. Dr. Huttner. ‘This means that the risk of bleeding is significantly higher up to almost two weeks after suffering from a brain haemorrhage. However, if you weigh up the risk of haemorrhage against the risk of blood clots forming, treatment with anticoagulants can restart in high-risk patients one week after a brain haemorrhage.’
For Prof. Dr. Stephan Achenbach, Director of Department of Medicine 2 – Cardiology and Angiology at Universitätsklinikum Erlangen 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 haemorrhage occurs in patients who have mechanical heart valves and who are taking anticoagulants.’
The results of the study called ‘Management of therapeutic anticoagulation in patients with intracerebral haemorrhage and mechanical heart valves’ have now been published in the European Heart Journal.