How should I treat a patient with a mechanical aortic valve prosthesis and recurrent intracranial bleeding on anticoagulation with a patent LIMA to LAD?

Tiffany Patterson1*, MBBS, BSc, MRCP; William R. Davies2, PhD, MRCP, MRCS; Ronak Rajani2, FRCP; Simon Redwood1, MD, FRCP, FACC; Christopher Young2, MD, FRCS (CTh); Martyn Thomas2, MD, FRCP; Johan Bosmans3*, MD, PhD; Inez Rodrigus4, MD, PhD; Serguei I. Melnitchouk5, MD; Thoralf M. Sundt III5, MD