Stroke in patients with mechanical heart valve prosthesis: Challenge of resumption of anticoagulation

Autor: Rachida Habbal, E.M. Aqli, Majda Haraka, Leila Azzouzi
Rok vydání: 2020
Předmět:
Zdroj: Archives of Cardiovascular Diseases Supplements. 12:100-101
ISSN: 1878-6480
DOI: 10.1016/j.acvdsp.2019.09.222
Popis: Introduction Patients with mechanical valvular prostheses are at high risk of embolism and excessive risk of bleeding by Warfarin, the vast majority of whom are cerebral. A sudden neurological deficit in a patient with a prosthetic valve requires brain imaging to determine whether it is an ischemic or haemorrhagic stroke. The decision to restart anticoagulation should be multidisciplinary to counterbalance the risk of cerebral hemorrhage and thrombosis of the prosthetic valve. Purpose The objective is to study the clinical and radiological evolution of patients with mechanical heart valve prostheses complicated by a cerebrovascular accident. Method A retrospective study spread over one year (November 2017 to November 2018) on 21 cases in the Cardiology Department of Ibn Rochd Casablanca Teaching Hospital. Results We report 21 observations of patients with cardiac mechanical prostheses placed under warfarin, hospitalized for stroke. Including 14 men and 7 women with an average age of 35 years. Of which 11 patients had mitral prostheses, 3 had aortic prostheses and 7 mitro-aortic prostheses. Of these patients, 15 had ischemic stroke and 6 hemorrhagic stroke (4 cases with ventricular flood). Radiological monitoring by brain CT from J0 and unfractionated heparin by self-injecting syringe was the method of choice for resuming anticoagulation in 17 patients in agreement with neurologists. The evolution was favorable in 13 patients (61, 9%) with a good relay to warfarin (10 AVCI and 3 AVCH), a haemorrhagic transformation in 5 patients with. We had death of 3 patients who had hemorrhagic stroke. Conclusion The prognosis can be put into play after the occurrence of stroke in patients with mechanical heart valves, a risk of cerebral hemorrhage in case of early resumption of anticoagulants and thrombotic risk of prostheses in case of a delayed recovery.
Databáze: OpenAIRE
Externí odkaz: