Management of intracranial bleeding associated with anticoagulation: balancing the risk of further bleeding against thromboembolism from prosthetic heart valves

Mechanical heart valves are associated with a risk of thromboembolism and a nticoagulation is generally recommended. However, this is inevitably associ ated with a risk of intracranial bleeding. The case of a patient who sustai ned an intracranial bleed while taking warfarin for a prosthetic aortic val ve and a further two intracranial bleeds while on heparin as an inpatient i s discussed and the literature on the management of intracranial haemorrhag e in patients on warfarin with prosthetic valves is reviewed.