Table of Contents
Thrombosis
Volume 2013, Article ID 346752, 4 pages
http://dx.doi.org/10.1155/2013/346752
Review Article

Anticoagulation for Prosthetic Valves

Department of Cardiac Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA

Received 27 July 2013; Revised 14 September 2013; Accepted 3 October 2013

Academic Editor: Giovanni de Gaetano

Copyright © 2013 Tsuyoshi Kaneko and Sary F. Aranki. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.