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Rebuttal to: choice of prosthetic valve in a developing country
  1. Iqbal H Jaffer1,2,
  2. Richard P Whitlock2,3
  1. 1Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada
  2. 2Division of Cardiac Surgery, McMaster University, Hamilton, Ontario, Canada
  3. 3Population Health Research Institute, Hamilton, Ontario, Canada
  1. Correspondence to Dr Richard P Whitlock, Population Health Research Institute, DBCVSRI, Room 1C1-5B, 237 Barton St. E., Hamilton, Ontario, Canada L8L 2X2; richard.whitlock{at}

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We read with interest the counterpoint suggesting that the best choice for the patient is a bioprosthetic valve. We acknowledge many of the points made by the authors,1 most importantly that the decision of valve prosthesis is a shared process between healthcare providers and patients. However, there several points that we feel need clarification.

The authors highlight the need for anticoagulation in the context of atrial fibrillation (AF), but then suggest that the differences in the International Normalised Ratio (INR) targets for patients with a mechanical heart valve and those in AF are substantially different. Looking at the …

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