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

  • Valvular Heart Disease (TL Kiefer, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The 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 Findings

Randomized, 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.

Summary

Patient-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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Authors and Affiliations

  1. Division of Cardiovascular Health and Disease, Department of Medicine, University of Cincinnati College of Medicine, 231 Albert Sabin Way ML 0542, CVC, Room 4936, Cincinnati, OH, 45267-0542, USA

    Mahboob Ali & Richard C. Becker

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  1. Mahboob Ali
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  2. Richard C. Becker
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Correspondence to Richard C. Becker.

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Conflict of Interest

Dr. Ali declares no conflict of interest.

Dr. Becker reports personal fees from Ionis, Akcea, and Novartis and grants from MyoKardia.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Valvular Heart Disease

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Ali, M., Becker, R.C. Bridging Anticoagulation with Mechanical Heart Valves: Current Guidelines and Clinical Decisions. Curr Cardiol Rep 22, 130 (2020). https://doi.org/10.1007/s11886-020-01390-2

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  • DOI: https://doi.org/10.1007/s11886-020-01390-2

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