Antithrombotic treatment for valve prostheses: Which drug, which dose, and when?

Despite the significant reduction of the overall burden of cardiovascular diseases (CVD), valvular heart disease (VHD) still represents an important cause of CVD morbidity and mortality. While the number of patients with prosthetic heart valves (PHV) is increasing, management of antithrombotic therapy in this setting remains particularly challenge. This happens also because the scientific guidelines and consensus documents rely on limited evidences. Nevertheless, the evolution in prostheses' materials, the spread of transcatheter interventions, and the introduction of direct oral anticoagulants (DOACs), altogether led to a scientific renaissance of this field. Our purpose is to examine and discuss the available evidences on the use of antithrombotic treatments in patients with mechanical and biological PHV, with the aim to provide a practical tool for decision making in every day clinical practice.