What factors should be considered when initiating OAC in patients with mechanical heart valves?
Choice of OAC should be made on an individual basis after stroke and bleeding risk assessment and discussion with the patient. Before an NOAC is initiated, the patient's age, body weight, and renal function should be considered to allow for appropriate dose adaptation where necessary. In frail patients and those at high risk of falls, an individual risk assessment needs to be undertaken prior to OAC initiation. In cases where the risk is that of mechanical falls, strategies to improve walking/reduce risk of tripping should be explored (ie, walking aids, appropriate footwear, home review to remove trip hazards), whereas neurological assessment is warranted if falls are unexplained.