Long-Term Suboptimal Anticoagulation in a Patient With Double Mechanical Heart Valves Leading to Stroke and Heart Failure

Mechanical heart valve replacements are highly durable and effective but come with a substantial requirement for lifelong anticoagulation therapy to prevent thromboembolic complications. Unlike biological valve replacements, which typically require less rigorous anticoagulation, mechanical valves - particularly in the aortic and mitral positions - present a higher risk for clot formation, necessitating strict adherence to anticoagulation regimens. This case report examines a 59-year-old male with double mechanical heart valve replacements who experienced poor compliance with anticoagulation therapy for over 30 years, ultimately leading to significant health complications. Despite his long-standing non-compliance, the patient initially avoided severe thromboembolic events until he suffered a stroke in 2022, followed by the onset of severe heart failure due to persistent suboptimal anticoagulation. His case is unique, given the prolonged lack of adherence to anticoagulation therapy, and highlights the critical need for consistent anticoagulation management in patients with mechanical heart valves. We explore the challenges of managing anticoagulation in complex cases and underscore the importance of consistent adherence to anticoagulation therapy, multidisciplinary intervention, and patient education in improving patient outcomes.