Antithrombotic Therapy in Valvular Heart

Y7 ew complications ofvalvular heart disease can be more.* ¦ devastating than systemic embolism. It is well recog¬ nized that antithrombotic therapy can reduce, although not eliminate, the likelihood of this catastrophe. If this therapy were risk free, all patients with valvular heart disease should be treated. Unfortunately, antithrombotic therapy, particularly with coumarin derivatives or heparin, carries a substantial risk of bleeding; that risk varies with the drug used, the intensity of the anticoagulant effect, and the clinical circumstances in individual patients. For example, risks of anticoagulant therapy are greater in patients with endocarditis, pregnancy, and bleeding dia¬ theses. This review will examine the risks of thromboembolism in various forms of valvular heart disease and attempt to establish strategies for using antithrombotic drugs in eac