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The indications for oral anticoagulant treatment have been extended over the last 10 years. The detection of new congenital thrombophilic risk factors, the studies on non-valvar atrial fibrillation, and the increase in valvar heart surgery have all led to a rise in the number of patients being treated. In 1997, 64 000 valve operations were performed across Europe; in two thirds of these operations mechanical prostheses were used, subsequently requiring lifelong oral anticoagulant treatment.w1
New developments in anticoagulation
Several recent developments in the management of anticoagulation with vitamin K antagonists can potentially improve the efficacy and safety of this treatment.
The introduction of the international normalised ratio (INR) as a measure of the intensity of anticoagulation has provided a reliable parameter for monitoring oral anticoagulant treatment, independent of the responsiveness of the thromboplastin used.1 w2 w3 All the expert committees have recommended the use of the INR instead of prothrombin time, although its acceptance has varied from country to country.
The development of the concept of risk factor adjusted, prosthesis specific intensity of anticoagulation2 w4 has influenced the management of patients with mechanical valve prosthesis and valvar heart disease in general, allowing risk stratification and lower anticoagulation intensities in certain lower risk groups of patients.
The results of prospective, randomised studies evaluating the effect of different intensities of anticoagulation on thromboembolic and haemorrhagic events allow a more targeted approach.3 ,4 w5 w6
The development of simple anticoagulation monitors has dramatically improved the quality of anticoagulation control.5 ,6
The guidelines developed by the working group on valvar heart disease of the European Society of Cardiology on the management of antithrombotic treatment in heart valve disease,2 together with the guidelines of the British Society of Haematology1 and the American Heart Association/American College of Cardiology (AHA/ACC),7have provided …