{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T17:54:47Z","timestamp":1792691687709,"version":"4.5.0"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,3,17]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Resuming anticoagulation in patients with mechanical heart valves after intracranial hemorrhage presents a clinical dilemma. The optimal timing must balance the risk of thromboembolism against hemorrhagic expansion. Prior studies have addressed this issue, but most were limited by small sample sizes. This systematic review and meta\u2010analysis aimed to determine the optimal timing for anticoagulation resumption in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">We conducted a systematic review and meta\u2010analysis using PubMed, Embase, Web of Science, and Scopus from database inception to August 23, 2024. The target population included adults with intracranial hemorrhage who required anticoagulation for mechanical heart valves.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Thirteen studies involving 788 patients were included: 12 retrospective and 1 prospective observational study. While off anticoagulation, 32 patients developed ischemic stroke, with a pooled event rate of 5.23% (95% CI, 3.80\u20137.20%) and negligible heterogeneity (\n                      <jats:italic toggle=\"no\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%). The pooled average time to stroke was 8.08\u2009days (95% CI, 1.99\u201314.18). After anticoagulation resumption, 73 patients experienced hemorrhagic recurrence, corresponding to a pooled event rate of 10.95%, with nonsignificant heterogeneity (\n                      <jats:italic toggle=\"no\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200940.4%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Withholding anticoagulation for up to 7\u2009days after intracranial hemorrhage in patients with mechanical heart valves appears relatively safe. Hemorrhagic recurrence after resumption was more common than ischemic stroke during interruption. However, the included studies were observational and carried serious or critical risk of bias. Prospective multicenter studies, and ideally randomized trials, are needed to provide more definitive evidence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.041301","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T11:34:30Z","timestamp":1773401670000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Resumption of Warfarin After Intracranial Hemorrhage in Patients With Mechanical Heart Valves: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5810-5292","authenticated-orcid":false,"given":"Amra","family":"Sakusic","sequence":"first","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5629-3023","authenticated-orcid":false,"given":"Sherief","family":"Ghozy","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]},{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0631-5436","authenticated-orcid":false,"given":"Yash","family":"Verma","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8401-6314","authenticated-orcid":false,"given":"Tasnim","family":"Elgazzar","sequence":"additional","affiliation":[{"name":"Alfaisal University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8359-2838","authenticated-orcid":false,"given":"Alejandro A.","family":"Rabinstein","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6257-1464","authenticated-orcid":false,"given":"Sherri A.","family":"Braksick","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eelco F. M.","family":"Wijdicks","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7479-6732","authenticated-orcid":false,"given":"Jennifer E.","family":"Fugate","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5431-1651","authenticated-orcid":false,"given":"Maximiliano A.","family":"Hawkes","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1212\/CPJ.0000000000000425"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-012-9704-2"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.123.032094"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2022.05.008"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2141.1998.01078.x"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1080\/00015458.2005.11679715"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/0090-3019(95)00249-9"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy056"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.21037\/atm-21-6848"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2016.02.033"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.57.12.1710"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000209664"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1017\/cjn.2019.331"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006123-199804000-00053"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000100"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.11"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1111\/rssa.12275"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.12305"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2022.114919"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1177\/23969873251340815"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.125.041301","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T11:13:01Z","timestamp":1782990781000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.125.041301"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,17]]},"references-count":20,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,3,17]]}},"alternative-id":["10.1161\/JAHA.125.041301"],"URL":"https:\/\/doi.org\/10.1161\/jaha.125.041301","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,17]]},"assertion":[{"value":"2025-01-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e041301"}}