Patient self-management and advances in mechanical valves may reduce anticoagulation requirements, potentially reversing the current trend favoring bioprosthetic valves.
May support self-management to favor mechanical valves; leaves open need for RCTs before practice change.
The choice of replacement heart valve has alternated many times during the past 40 years. The reason for the change is related to the balance between prosthesis longevity and the need for anticoagulation therapy. Bioprosthetic valves do not require continuous anticoagulation therapy but their expected life can be less than the patient's. Anticoagulation therapy for mechanical valves carries the risk of bleeding or thromboembolism. Research shows progress toward a mechanical valve that has a reduced thrombotic risk which may reduce the anticoagulation therapy requirements. Patient self-management of anticoagulation therapy results in more effective therapy with lower doses of anticoagulants. The current trend is more frequent use of bioprosthetic valves; however, this trend may again reverse as therapy for mechanical valves is refined.
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Slaughter et al. (2007) studied this question.
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