Resumption of anticoagulation during hypertensive cerebral hemorrhage with prosthetic heart valve.

To the Editor: We would like to bring to your attention our recent dilemma of when to re-anticoagulate a patient with a hypertensive cerebral hemorrhage who concurrently has a prosthetic heart valve. The patient, a 63-year-old woman, had had her aortic heart valve replaced in 1978 with a modified Bjork-Shiley prosthetic valve and had been taking warfarin without bleeding complications. She was also hypertensive and treated with enalapril. She was admitted to a local community hospital after having been found unconscious and was later noted to have a right hemiparesis with attention, language, and memory abnormalities. Computed tomography (CT scan) showed a left thalamic hemorrhage that had extended into the third ventricle, the internal capsule, and the caudate nucleus. The anticoagulant was stopped after admission, and she was transferred to our service a few days later.