Rebuttal to: choice of prosthetic valve in a developing country

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 the context of all other aspects of anticoagulation medicine, whether it is AF or venous thromboembolism, higher risk does not confer higher anticoagulation targets. 6 7 We give the example of the CHADS2 score where a CHADS2 score of 2 or 6 has an annualised stroke risk of 4 and 18.2%, respectively.