Antithrombotic treatment after heart valve surgery is of utmost importance depending on the type of used valve. Since in the early 1960s, oral anticoagulation with vitamin K antagonist are the gold-standard for prevention of thromboembolism at replaced heart valves. The introduction of new oral anticoagulation has dramatically changed treatment strategy in patients with atrial fibrillation and in patients with venous thromboembolism like deep vein thrombosis and pulmonary embolism. However, to date, the use of these newer drugs is contraindicated after implantation of mechanical heart valves for prevention of thromboembolism. Large trial revealed significantly higher rates of thromboembolism and bleeding events as compared to oral anticoagulation. Further studies are required to evaluate the several newer oral anticoagulations in patients with mechanical heart valve.