CRD Summary: The optimal management of oral anticoagulant therapy after intracranial bleeding secondary to vitamin K antagonist use in patients with a mechanical heart valve was investigated. The authors concluded that restarting or stopping anticoagulant therapy for a few days appeared to be safe, but the quality of evidence was low. The review was generally well conducted and the authors' conclusions appear appropriate.

[The antithrombotic therapies used were warfarin, enoxaparin, nadroparin, heparin and dipyridamole where reported.]

CRD Commentary: The research question was supported by inclusion criteria for participants, study design and intervention. Only published studies in four languages were sought, so the possibility of publication and language bias could not be ruled out. Study selection, data extraction and validity assessment were performed in duplicate, reducing the possibility of reviewer error and bias. The validity of observational studies appeared to have been assessed using relevant criteria. Narrative synthesis appeared appropriate given the heterogeneity of the included studies. The review was generally well conducted and, taking into consideration the limitations of the available evidence, the authors' cautious conclusions appear appropriate.