ThromboPhonia E02

The same 65-year-old man who was seen earlier with an ICH has now recovered. His past medical history is remarkable for hypertension, dyslipidemia, a mechanical aortic valve replacement, diabetes, and sleep apnea. His list of medications include ramipril, atorvastatin, aspirin, metformin, and warfarin. Should his anti-coagulation be resumed? If so, how long should the clinician wait prior to re-starting his medications? Objective 1: Summarize the most recent guidelines regarding when to re-start anti-coagulation after ICH (ASA, DVT-P, Xa inhibitors, warfarin) Objective 2: What factors need to be taken into consideration when making this decision? Objective 3: Interpret the evidence behind the guidelines Objective 4: Describe instances where one would consider re-starting anti-coagulation earlier/later Objective 5: Develop an approach to re-starting anti-coagulation after ICH including which agent to use and why Objective 6: How would you approach this scenario? Objective 7: What do guidelines suggest? Objective 8: Would scenario change depending on type of valve? What if the indication was AF, not mechanical valve? Objective 9: Does the type of bleeding matter? (lobar versus deep ICH)