Anticoagulation Targets after Valve Replacement.







ACC/AHA Recommendations for Antithrombotic Therapy in Patients With Mechanical Heart Valves:

 VKA Therapy
  • With mechanical aortic valve, VKA therapy with a target INR of 2.5 if no risk factors (atrial fibrillation, prior thromboembolism, left ventricular dysfunction, or hypercoagulable state) are present (Class I recommendation; Level of evidence: B)
  • VKA therapy with a target INR of 3.0 after:
    • Mechanical aortic valve replacement if risk factors are present (Class I recommendation; Level of evidence: B)
    • Mechanical aortic valve replacement with Starr-Edwards or disc valves other than Medtronic Hall if no risk factors are present (Class I recommendation; Level of evidence: B)
    • Mechanical mitral valve replacement with any type of valve (Class I recommendation; (Level of evidence: B)
 Antiplatelet Therapy
  • At a dose of 75 to 100 mg/day in addition to warfarin in all patients with mechanical valves (Class I recommendation; Level of evidence: A)


 ACC/AHA Recommendations for Antithrombotic Therapy in Patients With Bioprosthetic Heart Valves


 VKA Therapy with target INR of 2.5 (range 2.0 to 3.0):
  • For the first 3 months after bioprosthetic aortic valve replacement (Class IIb recommendation; Level of evidence B)
  • For the first 3 months after bioprosthetic mitral valve replacement (Class IIa recommendation; Level of evidence C)
 Antiplatelet Therapy
  • After bioprosthetic aortic or mitral valve replacement at a dose of 75 to 100 mg/day (Class IIa recommendation; Level of evidence: B)

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