Anticoagulant Management of Patients with Mechanical Prosthetic Valves Undergoing Non-Cardiac Surgery: Indications and Unresolved Issues
Yaron Shapira MD, Mordehay Vaturi MD, Alex Sagie MD

The management of anticoagulation in patients with prosthetic heart valve scheduled for non-cardiac surgery is controversial. The evidence on which the guidelines are based is derived from a few, small- to medium-sized studies, full of methodological flaws, and extrapolation of thromboembolic risk from data on patients not receiving oral anticoagulants at all is based upon assumptions that are not necessarily valid. This review critically explores the existing data and methodological problems such as small sample size, old valve models, and lack of risk stratification. Measures to overcome these drawbacks are offered.