Rebuttal to: choice of prosthetic valve in a developing country

We read with interest the counterpoint suggesting that the best choice for the patient is a bioprosthetic valve. We acknowledge many of the points made by the authors,1 most importantly that the decision of valve prosthesis is a shared process between healthcare providers and patients. However, there several points that we feel need clarification. The authors highlight the need for anticoagulation in the context of atrial fibrillation (AF), but then suggest that the differences in the International Normalised Ratio (INR) targets for patients with a mechanical heart valve and those in AF are substantially different. Looking at the evidence, however, would seem to suggest that the guidelines supporting higher anticoagulation for mechanical valves in the mitral position are based on small studies of low quality, and the strength for this recommendation is weak.2–5 We would argue that, in...
Source: Heart Asia - Category: Cardiology Authors: Tags: Debates in cardiovascular medicine Source Type: research