Mechanical heart valves (MHVs) require effective anticoagulation to prevent thromboembolic events, but traditional anticoagulation strategies present challenges such as bleeding risk and patient compliance. This article reviews innovative anticoagulation strategies for patients with MHVs, including novel anticoagulants, personalized dosing approaches, and advanced monitoring techniques. By summarizing recent research and clinical advances, we aim to provide a comprehensive overview of contemporary approaches to anticoagulation in MHV patients.