Cardiogenic shock is characterized by hypotension along with signs of hypoperfusion. It has been defined by various societies and clinical trials in different manner. Acute myocardial infarction is the most common cause of cardiogenic shock. Despite early percutaneous coronary intervention, shock secondary to acute coronary syndrome carries mortality rates reaching up to 40–50%. Mechanical circulatory support has been designed to potentially improve outcomes in such patients, but data remains scarce on mortality benefits and long-term outcomes.

Novel oral anticoagulants, with dabigatran in particular have failed in their quest to replace the traditional anticoagulation in the form of vitamin K antagonist in patients with mechanical valvular implants. However, the same had not been tried in bioprosthetic valve recipients until recently in a large trial where rivaroxaban was found to be non-inferior to warfarin on head-to-head basis. This commentary discusses the various aspects related to oral anticoagulation in bioprosthetic valve recipients in the light of recent clinical evidence.