[Anticoagulation in surgery, after hemorrhagic complications and in pregnancy]

A review of the current management of the anticoagulated patient with heart valve prosthesis is presented. All patients with mechanical heart valve prostheses require life-long oral anticoagulation with coumarin or one of its derivatives. Recommendations for the prevention of thromboembolic events and bleeding complications in patients undergoing noncardiac operations are given. Furthermore, risk factors for hemorrhagic complications during long-term oral anticoagulation are discussed as well as management in case of acute bleeding. The advantages and disadvantages of three different treatment approaches to anticoagulation during pregnancy are discussed with delineation of specific risks for the mother and the fetus.