Dabigatran and Mechanical Heart Valves — Not as Easy as We Hoped

Warfarin is the mainstay of anticoagulation for patients with mechanical heart valves. However, warfarin has well-known limitations, including interactions with food and drugs and the requirement for lifelong monitoring of the international normalized ratio (INR).1 Variability of the INR is the strongest independent predictor of reduced survival after mechanical valve replacement.2 Thus, there is a pressing need for alternatives to warfarin, and the advent of the target-specific oral anticoagulants has been highly anticipated.Eikelboom et al.3 now report in the Journal the results of a study whose primary aim was to validate a new dosing regimen for dabigatran, as compared . . .