Prevention of thromboembolic events in valvular heart disease.

Thromboembolic events are major causes of morbidity and mortality in patients with native heart valve disease and artificial heart valves. Oral anticoagulation can reduce these complications. The indication for and intensity of oral anticoagulation depends on both, the risk for thromboembolic events and the risk of hemorrhage. The indications for oral anticoagulation in the various pathological conditions are defined. Risk factor adjusted intensity of oral anticoagulation and risk factor modification are new and very important aspects in the management of these patients which may lead to a reduction in anticoagulation associated complications and an improvement in antithrombotic effectivity. Further studies to identify the optimal therapeutic ranges of anticoagulation for the individual patient are needed. Multi-centre prospective randomized studies in this field should help us to answer the still open questions including new hemostatic molecular markers to further identify patients with different risk profiles.