Key result
Warfarin remains the standard for mechanical valve anticoagulation, as dabigatran increases adverse events, though newer On-X valves may allow for lower anticoagulation targets.
Warfarin remains the standard for mechanical valves, as dabigatran increases adverse events, though lower anticoagulation targets may be safe for newer generation On-X valves.
Reinforces warfarin as standard for mechanical valves; leaves open lower targets for On-X valves pending RCTs.
Implantation of prosthetic valve requires consideration for anticoagulation. The current guideline recommends warfarin on all mechanical valves. Dabigatran is the new generation anticoagulation medication which is taken orally and does not require frequent monitoring. This drug is approved for treatment for atrial fibrillation and venous thromboembolism, but the latest large trial showed that this drug increases adverse events when used for mechanical valve anticoagulation. On-X valve is the new generation mechanical valve which is considered to require less anticoagulation due to its flow dynamics. The latest study showed that lower anticoagulation level lowers the incidence of bleeding, while the risk of thromboembolism and thrombosis remained the same. Anticoagulation poses dilemma in cases such as pregnancy and major bleeding event. During pregnancy, warfarin can be continued throughout pregnancy and switched to heparin derivative during 6-12 weeks and >36 weeks of gestation. Warfarin can be safely started after 1-2 weeks of discontinuation following major bleeding episode.
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Kaneko et al. (2013) conducted a review in Prosthetic valves. Anticoagulation was evaluated. Warfarin remains the standard for mechanical valve anticoagulation, as dabigatran increases adverse events, though newer On-X valves may allow for lower anticoagulation targets.
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