Surgery for patients with mechanical heart valves: Adjustment and tailoring of anticoagulant therapy

Valvular surgery in patients (pts) with long history of cardiac valve disease is accomplishing improvement of symptoms, functional status and longevity. The numbers are very big also in our country. Our census numbers are not reliable, but estimation of above 15000 pts with prosthetic heart valve implants is close to correct. Since significant increase in survival and longevity of those pts, the possibility and necessity for non cardiac operative procedures are also increased. Because of specificity and complex constant regular anticoagulation therapy in order to prevent catastrophic prosthetic valve thrombosis and common thromboembolic complication good, but safe reduction of anticoagulation status to accomplish also safe haemostatic condition necessary for all surgical procedures. Individual adjustment and tailoring of anticoagulant and anti aggregation therapies according to accepted international protocols should be carefully done with necessery variation depending on the non cardiac organ and system involved: urgent either minor or major surgical interventions; bleeding peptic ulcer; elective surgery including ophtalmic and common dental procedures with risk of bleeding.