Page 140 - Clinical Pearls in Cardiology

128 Clinical Pearls in Cardiology

Due to the thrombogenic nature of all mechanical
prostheses, patients who receive such a prosthesis
should be put on long-term anticoagulant medications.
The thrombogenic potential is believed to be highest
for the older generation ball and cage valves, while the
single tilting disc valves have been reported to have a
lower thrombogenicity. It is generally believed that the
latest generation of bileaflet prostheses have the lowest
risk of thromboembolism. So all the major guidelines
recommend that patients with mechanical prosthetic
valves should be treated with warfarin to achieve a target
INR between 2.5 and 3.5. The intrinsic thromboembolic
potential of bioprosthetic valves are lower than that of
mechanical valves, and long-term anticoagulation is
generally not required.