[Current recommendations for prevention of thromboembolism in patients with heart valve prostheses]

Within the last few years, marked progress has been made in the prevention of thromboembolic events in patients with mechanical heart valves. Thus, therapy has become more effective and is associated with less risk. This includes a number of developments like the introduction of the internationalized, normalized ratio (INR) for determination of the intensity of anticoagulation, the concept of a risk factor-adjusted, prosthesis specific, individualized indication for and intensity of anticoagulation and the possibility for self-determination of anticoagulation intensity by the patient. Prospective, randomized studies on the effect of different intensities of anticoagulation allowed definitions of individualized anticoagulation target levels and were the basis for guidelines on clinical management of anticoagulation. In spite of this progress, thromboembolic complications and anticoagulation associated bleedings are still the most frequent complications after valve replacement. The guidelines published by the professional societies on anticoagulation should be followed more closely in daily clinical practice. The management of oral anticoagulant treatment can be improved by following the concept of a risk factor-adjusted indication for and intensity of oral anticoagulant treatment as well as the use of the INR for monitoring the intensity of anticoagulation. Intensive education of the patient, implementation of self-testing by suitable patients and increasing the frequency of testing can further contribute to improvement.