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, patient attitude and lifestyle, associated diseases and medications, etc, all must be considered. Also, because each variable may change with time, a proper decision at one time in a patient's life may be inappropriate at another time. In some instances, too, the literature on a given subject is sparse or contains conflicting data which further confound the issue. Since the data base 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.