Anticoagulation Management for Mechanical Valves in the On-X Era

The first mechanical aortic valve was surgically implanted 70 years ago. As the engineering of mechanical heart valves and surgical survival improved, advancements in valve technologies were then expanded for uses in the mitral positions. Interestingly, thromboembolic events were quite common in these early surgical valves and systemic anticoagulation was needed to prevent thromboembolic events. Improvements in the materials composing the valves and the overall valve design have led to changes in anticoagulation management for patients with mechanical valves. The purpose of this chapter is to review the current indications, complications, and guidelines for the use of anticoagulation for patients with implanted mechanical valves in either the aortic and mitral positions.