title: Modern management of prosthetic valve anticoagulation.
abstract: Prosthetic heart valves have been effectively used for many years. Nonetheless, they are associated with risks of thrombosis and thromboembolic events, as well as anticoagulation-induced bleeding. Substantial changes in anticoagulation measurement and dosing have occurred during the past several years. In this review, the rationale for anticoagulation in patients with prosthetic heart valves, the changes in monitoring and dosing, and the comparison of relevant anticoagulation trials are discussed. On the basis of the existing data, new recommendations regarding lower anticoagulation levels are offered, utilizing a single value goal rather than the traditional therapeutic range. Perioperative management of anticoagulation is discussed in light of the available literature, and major drug interactions are reviewed.
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic Rochester, MN 55905, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Tiede
authors.forename: R A
authors.initials: RA
authors.lastname: Nishimura
authors.forename: D A
authors.initials: DA
authors.lastname: Gastineau
authors.forename: C J
authors.initials: CJ
authors.lastname: Mullany
authors.forename: T A
authors.initials: TA
authors.lastname: Orszulak
authors.forename: H V
authors.initials: HV
authors.lastname: Schaff
mesh_terms: D000925:Anticoagulants / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D004032:Diet; D005260:Female; D018565:Food-Drug Interactions; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000517:prevention & control; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D014812:Vitamin K / Q000008:administration & dosage; D014859:Warfarin / Q000493:pharmacokinetics / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014812:Vitamin K; D014859:Warfarin