Válvulas mecânicas não seguem a moda na Inglaterra

We wish to confirm and re­iterate to managers, commissioners, healthcare professionals and patients that, at
present, none of the novel oral anticoagulant drugs (dabigatran, edoxaban, apixaban & rivaroxaban) are
licensed for use in patients with mechanical heart valves and, in fact, they are contra­indicated in patients
with mechanical valves as per both European[3] and North American[4] clinical practice guidelines because of
a higher incidence of thrombo­embolic complications when compared to warfarin.

https://www.bsecho.org/Public/News/Articles/2021/2021-08/20210809-Joint%20Statement.aspx

Anticoagulation of Patients with Mechanical Heart Valves
A Joint Statement from the British Heart Valve Society (BHVS), the Society for Cardiothoracic
Surgeons (SCTS), the British Society of Echocardiography (BSE), the Primary Care Cardiovascular Society
(PCCS), the British Congenital Cardiac Association (BCCA) and the British Cardiovascular Society (BCS)