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Hiteshi K.C. Chauhan: Why Mechanical Valve Thrombosis Is a Systems Failure, Not Just an Anticoagulation Error
Hiteshi K.C. Chauhan/LinkedIn
Sep 23, 2026, 12:34

Hiteshi K.C. Chauhan: Why Mechanical Valve Thrombosis Is a Systems Failure, Not Just an Anticoagulation Error

Hiteshi K.C. Chauhan, Consultant, Department of Cardiology at Fortis Healthcare, shared a post on LinkedIn:

“We’ve all experienced this incredible moment in our clinical practice.

  • A thrombosed mechanical mitral valve.
  • Low-dose, slow-infusion thrombolysis.
  • And then – the leaflets move again.

The tragedy: In LMICs, we see this more often than we would want to.

Thank you, Rheumatic Heart Disease.

For young patients receiving a mechanical valve, lifelong anticoagulation becomes essential.

Yet a study of 552 patients with RHD and mechanical valves found that only 27% of INR measurements were therapeutic, while 61% were subtherapeutic.

By year seven, INR testing had fallen to less than once a year.

Valve thrombosis is – therefore – not simply an anticoagulation failure. It is a systems failure surrounding a lifelong therapy.

We know what works:

  • Reliable INR testing
  • Affordable, consistent access to medication
  • Continuity of care
  • Long-term follow-up

The real challenge is implementation.

How do we make what works accessible at scale?

Case of low-dose, slow-infusion thrombolysis courtesy of JAMA Cardiology.”

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