Antithrombotic Therapy in Valvular Heart Disease

The decision to initiate long-term anticoagulant therapy in a patient with valvular heart disease is frequently difficult because of the many variables that influence the risks of thromboembolism and of bleeding in a given individual. The patient's age, the specific valve lesion, the heart rhythm, the duration of the valve disease, a history of thromboembolism, patient attitude and life-style, associated diseases, and medications all must be considered. Because the state of such variables may change with time, a proper decision at one time in a patient's life may be inappropriate at another time. In some instances, the literature on a given subject is sparse or contains conflicting data that further confound the issue. Since the database for these guidelines is constantly being modified, particularly as a consequence of new randomized clinical trials, the clinician would do well to review his decision at frequent intervals.