To Anticoagulate or Not? That Is the Question. Management of High-Risk Patients with Mechanical Mitral and Double Valves: A Case Series

The Achilles heel of mechanical valves appears to be the need for anticoagulation. Several different types of mechanical valves have come and gone. The success or lack thereof of these valves depended on their various designs. We compared the two most promising mechanical valves of different eras and the need for anticoagulation through a case review. Both the Medtronic-Hall tilting disc valve and the bileaflet On-X valve were compared and contrasted in terms of durability and management of anticoagulation in high-risk patient populations. We present two cases of challenging anticoagulation management: a patient who underwent a mitral valve replacement with a Medtronic-Hall tilting disc valve who was off anticoagulation for close to six years, and a patient who underwent On-X mitral and aortic valve replacements and suffered a subsequent intracranial bleed requiring surgical intervention. We explore the ethical dilemmas associated with these patients and the risk of restarting anticoagulation for each.