Background: In patients with MHV after a recent ICH, clinicians must balance the thromboembolism risk from anticoagulation interruption with the danger of hematoma expansion upon resuming anticoagulation. 

Methods: We systematically searched MEDLINE, Embase, and Cochrane Library for studies up to July 2024. Studies were included if they evaluated the anticoagulation resumption in patients with MHV after ICH. We used R software 4.3.1 for all statistical analyses. The random-effects model was used for all outcomes and heterogeneity was assessed with I².

Results: Seven observational studies were included, comprising 465 patients. Only one study resumpted anticoagulation < 7 days. The strategies in remaining studies were the following: resumption in <7 days, >7 days or no resumption. The median time of resumption ranged from 2 days to 30 days. The risk of the expansion of ICH was 8.95% (95% CI, 6.48-12.24; I²= 0%), reported by 4 studies. The mortality rate was 10.28% (95% CI; 3.87-24.60; I²= 76%) and thrombotic complications was 9.50% (95% CI; 5.70-15.42; I²=36%). 

Conclusion: These findings emphasize the need for careful timing of anticoagulation resumption in patients with mechanical heart valves after intracranial hemorrhage. Despite potential tolerance for early resumption, the considerable rates of thrombotic events and mortality necessitate individualized management. Future research should focus on patient factors influencing outcomes and developing guidelines to balance thromboembolic risks with hematoma expansion.