Antithrombotic therapy for patients with valvular heart disease

To avoid the devastating consequences of thromboembolism and bleeding in patients with valve disease, in particular those with prosthetic valves, it is of utmost importance to correctly manage anticoagulation.Patients with mitral stenosis and either permanent or paroxysmal atrial fibrillation should receive anticoagulation, whereas those in sinus rhythm should only receive it in selected cases. In patients with prosthetic valves, anticoagulation management should be governed by the risk-benefit ratio taking factors related both to the patient and the prosthesis into account. Aspirin should be added only when there is a specific indication, such as concomitant arterial disease or embolism. In the future, improvements will be the result of the development of less thrombogenic valve substitutes, increased performance of conservative procedures, development of new antithrombotic agents, and, finally, increased use of self-assessment by better-educated patients.