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            <i>American Journal of Medicine</i>          </div>
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<h2><span style="font-size:12px;">Hylek - Prevention and Treatment of Venous Thromboembolism - Figure 19</span><br />Absolute Contraindication: Prosthetic Heart Valves</h2>



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      <p>An important contraindication concerns patients with a prosthetic heart valve. &nbsp;All of these new anticoagulants should be avoided in any patients with prosthetic heart valves. &nbsp;A recently published study<span class='ref_num'>[14]</span> looking at <span class="GINGER_SOFATWARE_spelling" ginger_sofatware_uiphraseguid="a20f21ef-29da-4ac4-8620-d4afb5363053">dabigatran</span> demonstrated that there are not only more thromboses but also an increased risk of major bleeding with these agents. &nbsp;So patients with a prosthetic heart valve who develops a DVT cannot be treated with one these new agents and will have to remain on <span class="GINGER_SOFATWARE_noSuggestion GINGER_SOFATWARE_correct" grcontextid="warfarin:0" ginger_sofatware_markguid="ff40703b-ba10-40b2-ad84-1d321f7b988e" ginger_sofatware_uiphraseguid="7121fba5-e393-42c9-b87e-e4dcd500d381">warfarin</span>.<span style="line-height: 1.4;">&nbsp;</span><font color="#000000" face="Times New Roman" size="3"><span style="color: rgb(51, 51, 51); font-family: &quot;Helvetica&quot;,&quot;sans-serif&quot;; font-size: 9pt; mso-fareast-font-family: Times; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;"></span><span style="font-family: Helvetica, sans-serif; font-size: 9pt;"><b><span class="GINGER_SOFATWARE_noSuggestion GINGER_SOFATWARE_correct" grcontextid="Hylek:1" ginger_sofatware_markguid="d7a7d40f-f392-46d2-8acc-88c47bd38585" ginger_sofatware_uiphraseguid="7121fba5-e393-42c9-b87e-e4dcd500d381">Hylek</span> E. <i>Am J <span class="GINGER_SOFATWARE_correct" grcontextid="Med:0" ginger_sofatware_markguid="7068a6bc-5ece-4d02-977c-b9427b1be48a" ginger_sofatware_uiphraseguid="21020d3c-27df-40af-b2c3-c45c58bbe527">Med</span></i> 2013; </b>published on-line at </span><span style="color: rgb(0, 0, 102); font-family: &quot;Helvetica&quot;,&quot;sans-serif&quot;; font-size: 9pt; mso-fareast-font-family: Times; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA; mso-bidi-font-size: 10.0pt; mso-bidi-font-family: AdvOT3c2d9f11;">http://education.amjmed.com/00000.</span><u1:p></u1:p></font><span style="line-height: 1.4;">&nbsp;</span><br><span class="GingerNoCheckStart"></span></p>
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  <h2>References</h2>
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    <span class="ref_num">[14]</span> Van de Werf F, Brueckmann M, Connolly SJ, et al. A comparison of dabigatran etexilate with warfarin in patients with mechanical heart valves: The Randomized, phase II study to Evaluate the sAfety and pharmacokinetics of oraL dabIGatran etexilate in patients after heart valve replacemeNt (RE-ALIGN) randomized, phase II study to evaluate the safety and pharmacokinetics of oral dabigatran etexilate in patients after heart valve replacement (RE-ALIGN). <i>Am Heart J</i>. 2012;163:931-937.  </p>
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