Antithrombotic Therapy in Valvular Heart Disease

Abstract

Few complications of valvular heart disease can be more devastating than systemic embolism. With little regard for the severity of the underlying valve lesion, a cerebral or mesenteric embolus in a moment's time may cripple or kill a previously healthy patient. It is well recognized that antithrombotic therapy can reduce, although not eliminate, the likelihood of this catastrophe. If this therapy were risk-free, all patients with valvular heart disease would be appropriate candidates for treatment. Unfortunately, antithrombotic therapy, particularly warfarin derivatives and heparin, includes an important risk of bleeding, which varies with the drug used, the intensity of the anticoagulant effect, and the clinical circumstances in individual patients. For example, risks of anticoagulant therapy are greater in older patients, endocarditis, pregnancy, and many other clinical situations.