What is contraindicated in patients with mechanical heart valves?

In patients with mechanical heart valves, the use of direct oral anticoagulants (DOACs) is contraindicated primarily due to their lack of established efficacy and safety in this special population. Mechanical heart valves require lifelong anticoagulation to prevent thromboembolic events, such as stroke. The standard treatment for these patients has historically involved the use of vitamin K antagonists like warfarin, which has a well-documented track record of managing the anticoagulation needs for individuals with mechanical valves.

Current recommendations emphasize that because DOACs have not undergone sufficient testing in those with mechanical heart valves, they do not have an approved indication for this population. Patients with mechanical valves are at a higher risk for thrombosis, and the predictable anticoagulation achieved with warfarin and its ability to adjust dosing based on INR monitoring is vital for patient safety.

In contrast, other options such as aspirin use or regular INR monitoring are appropriate and often utilized in the management of patients with mechanical heart valves. Vitamin K supplementation, while generally not used in patients who are on anticoagulation therapy, may also be necessary in certain clinical situations to manage warfarin therapy, but it should be done cautiously.