Anticoagulation in patients with mechanical heart valves: follow the guidelines!

Heart valve surgery has been one of the great leaps forward in the management of heart disease in the last 60 years. Thanks to technical developments, artificial heart valves were constructed that prove to be competent and durable. Besides the risk of infective endocarditis, thromboembolism from the foreign body structures of the prosthesis remains a major problem, which can be effectively reduced, but not annihilated by the use of oral anticoagulants. For nearly all patients on oral anticoagulants, bleeding is the most common problem. The only available and proven effective oral anticoagulants for carriers of mechanical heart valve prosthesis are the vitamin-K antagonists (VKA). They need intensive monitoring of the anticoagulation status through the dense network of thrombosis clinics in the Netherlands. Recently, non-VKA direct-acting oral anticoagulants were introduced, which are safer and more effective than VKA in stroke prevention in atrial fibrillation [1]. They have also been tested in patients undergoing mechanical heart valve replacement and in those with recent implantation, but here they failed in efficacy and safety in comparison with VKA [2]. Thus, VKA remains the standard of anticoagulation care for patients carrying artificial heart valves.