Anticoagulants are generally contraindicated in patients with intracerebral hematoma. However, in patients with prosthetic heart valves it may be dangerous to withhold such therapy because of possible thromboembolic complications. We treated four such patients with i.v. heparin starting early after the hemorrhage. The hematomas receded in all patients according to the follow-up CTs, and none had thromboembolic disorders. Three patients had good outcomes, and one remained in a persistent vegetative state after an event of acute pulmonary edema.