Managing anticoagulation in patients with mechanical valves

As the burden of valvular heart disease increases worldwide, surgical valve replacement with mechanical prostheses continues to be an important treatment option for thousands of patients each year. All patients with mechanical heart valves require oral anticoagulation with vitamin K antagonists. The optimal dose and intensity of anticoagulation depends on patient- and valve-related risk factors. Clinical management is further complicated during pregnancy or surgery because antithrombotic therapy may need to be altered and decisions are often based on limited, observational data. Novel therapies that may overcome many of the inherent limitations associated with vitamin K antagonists are currently being developed and tested as alternative anticoagulants in different patient populations.