Lieberman A, Hass W K, Pinto R, Isom W O, Kupersmith M, Bear G, Chase R
Stroke. 1978 Jan-Feb;9(1):18-24. doi: 10.1161/01.str.9.1.18.
In 1 year 6 patients with prosthetic heart valves (PHVs) treated with anticoagulants suffered intracranial hemorrhage. In 4, hemorrhage occurred into the site of a recent non-hemorrhagic infarction. In the others, both of whom had endocarditis, hemorrhages probably occurred as the result of rupture of a mycotic aneurysm. Five patients were treated with warfarin, 1 with heparin. In all patients the level of anticoagulant activity was greater than 1.5 times control. Five patients were in atrial fibrillation; 1 was hypertensive. The diagnosis of intracranial hemorrhage was made and its location and extent accurately determined by computed tomography (CT). Three patients underwent surgery and 2 are alive with only minor neurological deficits. Among the 3 patients who did not undergo surgery 2 died and 1 is alive with a moderate neurological deficit. The management of PHV patients with use of anticoagulants is discussed in terms of the mechanisms involved in intracranial bleeding. Emphasis is placed on prevention of emboli, discontinuation of anticoagulants once non-hemorrhagic infarction has occurred and the primacy of CT scan in diagnosis when hemorrhage is suspected. The special problems of anticoagulation in the presence of endocarditis are also discussed.
1年内，6例接受抗凝治疗的人工心脏瓣膜（PHV）患者发生了颅内出血。其中4例出血发生在近期非出血性梗死部位。另外2例患者患有心内膜炎，出血可能是由霉菌性动脉瘤破裂所致。5例患者接受华法林治疗，1例接受肝素治疗。所有患者的抗凝活性水平均高于对照的1.5倍。5例患者为心房颤动；1例为高血压患者。通过计算机断层扫描（CT）做出了颅内出血的诊断，并准确确定了其位置和范围。3例患者接受了手术，2例存活，仅有轻微神经功能缺损。在未接受手术的3例患者中，2例死亡，1例存活，有中度神经功能缺损。根据颅内出血所涉及的机制，讨论了使用抗凝剂的PHV患者的管理。重点强调了预防栓塞、一旦发生非出血性梗死即停用抗凝剂以及在怀疑出血时CT扫描在诊断中的首要地位。还讨论了存在心内膜炎时抗凝的特殊问题。
