Abstract: Intruduction :Valve replacement surgery has dramatically improved the outcomes of the patients with valvular heart disease. In the last few years it has been estimated that about 280 000 valve substitutes are annually implanted worldwide 1.nevertheles prosthetic valve comploications are many, including valve thrombosis and subsequently systemic embolism, these two main impacts of the prosthetic valves can be minimized by using oral anticoagulant therapy and the main antithrombotic treatment used is coumarin derivatives, commonly warfarin, which can reduce the risk of the thromboembolic events to approximately 1 in 100 patients 2. Despite this significant effect of warfarin, it has serious side effect especially in prosthetic valve patients, as they may develop major bleeding which can be fatal if it is not managed accordingly. Methods :This study tried to focus on the incidence of the bleeding in one of Iraqi specialized cardiac centres and finding out what are the major sites of bleeding with the outcomes of each one, comparing it to the previously conducted studies. Results : 25% of mortalities was due to intracranial bleeding in spite of admission and intensive care Authers: Dr,Sadoon H. Al Hayazie ,MBCHB,FICMS cardiothoracic . Dr Bassam AL Alousi ,MBCHB,FICMS cardiothoracic.