Antithrombotic therapy following implantation of heart valve prostheses

Although the optimal intensity of oral anticoagulation has not been proved by prospective studies so far, general recommendation is an intensity equivalent to an international normalised ratio (INR) of 3.0-4.5 for patients following mechanical heart valve implantation. Recent investigations regarding the optimal management of oral anticoagulation in patients carrying prosthetic heart valves have shown a) a superiority of anticoagulation management by use of the INR instead of the prothrombin lime or the "Quick" levels, b) differences in the overall thrombogenicity of old as well as of more recently introduced prostheses, c) he necessity to adapt the anticoagulation intensity individually according to he patient related coagulability an one hand and cardiac morphology and physiology potentially predisposing to intracardiac thrombus formation on he other hand, and d) he potential benefit of patient education and self management of oral anticoagulation therapy as well as the individual self adjustment of anti-coagulation dosis may have.