Donaldo E. Silva-López, Departamento de Cardiología, Medicina Interna, Hospital Civil de Guadalajara, Universidad Autónoma de Guadalajara, Secretaría de Salud, Guadalajara, Jal., México
Marco A. Ponce-Gallegos, Departamento de Cardiología, Instituto de Cardiología Ignacio Chávez, Secretaría de Salud, Ciudad de México, México
César Márquez-Acéves, Departamento de Infectología, Medicina Interna, Hospital Civil de Guadalajara, Universidad Autónoma de Guadalajara, Secretaría de Salud, Guadalajara, Jal., México
Anett C. Ortíz-Pérez, Departamento de Medicina Interna, Hospital Civil de Guadalajara, Universidad Autónoma de Guadalajara, Secretaría de Salud, Guadalajara, Jal. México
The management of patients with acute intracerebral hemorrhage and mechanical heart valves on therapeutic anticoagulation is challenging. This case involves a 53-year-old female patient with a history of rheumatic fever and valve prostheses, who developed an intracerebral hemorrhage while on therapeutic anticoagulation with a vitamin K antagonist (acenocoumarin). With a controlled INR of 3.10, she presented with a headache and altered state of alertness. A non-contrast cranial CT scan showed a left frontal hematoma of 51 cc. Anticoagulation was discontinued, and the INR was normalized to 1.1. After two weeks without anticoagulation and neurological improvement, anticoagulation was gradually resumed, maintaining an INR of 3 without thromboembolic complications. The case highlights the need of individualize the resumption of anticoagulation in these patients.
Keywords: Intracerebral hemorrhage. Mechanical heart valves. Anticoagulation. Acenocoumarin. Thromboembolic risk.