Thromboembolic complications and anticoagulation-related bleeding are by far the most prevalent contributors to morbidity and mortality after surgery for mechanical heart valve (MHV).

The mainstay of treatment in guidelines remains indefinite anticoagulation with a vitamin K antagonist (VKA). The benefits of VKA therapy after MHV placement are marked.

Given the narrow therapeutic index, interactions, genetic variants, and need for blood monitoring of patients taking VKAs, it is necessary to evaluate new alternatives such as Factor Xa inhibitors.