ThromboPhonia E02 - a podcast by The CanadiEM.org Team

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)