Anticoagulation in Patients with Mechanical Heart Valves: Less is More?

Valvular heart disease is diffused worldwide and is associated with significant morbidity and mortality.[1] Surgical valve replacement is the treatment of choice when valve repair is impossible. Both biological and mechanical prosthetic (biological and mechanical heart valves [BHV and MHV]) valves are available: BHVs have a shorter duration than MHVs but are associated with a lower thrombotic risk than MHVs, which require lifelong anticoagulation. Patients with MHVs are, therefore, exposed to a not negligible thromboembolic and bleeding risk, and the burden associated with the management of anticoagulation may substantially affect the quality of life. Unfortunately, direct oral anticoagulants were shown a lower safety and efficacy when compared with vitamin K antagonists (VKAs) in this setting, and no alternative life-long treatment to VKAs is recommended for MHV patients.[2] [3]