Antithrombotic therapy for prosthetic valves: routine treatment and special considerations.

The use of prosthetic heart valves has increased over the past 3 decades. Antithrombotic agents remain the mainstay of therapy to prevent thromboembolic events caused by the presence of a prosthetic heart valve. We examine the risks of thromboembolic events as well as the risks and benefits of antithrombotic therapy in patients with mechanical and bioprosthetic heart valves. We also review the data regarding the use of antithrombotic therapy in special groups of patients, such as those with intracranial bleeding, pregnant women with prosthetic heart valves, and patients with prosthetic heart valves undergoing surgery.