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Bridging Anticoagulation with Mechanical Heart Valves: Current Guidelines and Clinical Decisions

Authors
  • Ali, Mahboob1
  • Becker, Richard C.1
  • 1 University of Cincinnati College of Medicine, 231 Albert Sabin Way ML 0542, CVC, Room 4936, Cincinnati, OH, 45267-0542, USA , Cincinnati (United States)
Type
Published Article
Journal
Current Cardiology Reports
Publisher
Springer-Verlag
Publication Date
Sep 10, 2020
Volume
22
Issue
11
Identifiers
DOI: 10.1007/s11886-020-01390-2
Source
Springer Nature
Keywords
License
Yellow

Abstract

Purpose of ReviewThe management of patients with mechanical heart valves who require surgery or invasive procedures is a common clinical scenario in contemporary practice. The risk of thromboembolism versus the risk of bleeding is the foundation of optimal patient care.Recent FindingsRandomized, controlled trials are not available; yet, there is a wealth of experience to guide best practice. Current guidelines represent a compilation of data from trials of atrial fibrillation and expert opinion. Results from the PERI-OP trial of patients with either a mechanical heart valve, atrial fibrillation, or atrial flutter requiring interruption of oral anticoagulant therapy for surgery will inform clinical practice.SummaryPatient-specific factors and valve-specific factors are paramount when deciding whether a period of anticoagulant therapy interruption is safe. Similarly, the safety and efficacy of bridging anticoagulant therapy and the optimal time after surgery for restarting oral anticoagulants is vital to optimal patient care.

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