Cardiovascular Critical Care I

Three guidelines exist regarding valve anticoagulation, with varying agreement in the recommendations.

occurs during diastole) versus aortic valves, where blood flow across the valve is active occurring

during systole.

Available at http://circ.ahajournals.org/content/early/2017/03/14/CIR.0000000000000503)

Procedure

Warfarin,

Target INR Range

Class of

Recommendation/

Level of Evidencea

Antiplatelet

Therapy

Class of

Recommendation/

Level of Evidencea

Mechanical AVR

2–3 (bileaflet or current-

generation single-tilting

disc and no risk factors

for thromboembolismb)

IB

Aspirin 81 mg daily

may be considered

if indicated for

antiplatelet therapy

and bleeding risk

is low

IIb/B

2.5–3.5 (older-generation

[i.e., ball-in-cage valve,

or with additional

risk factors for

thromboembolismb])

IB

For a mechanical

On-X AVR and no

thromboembolic risk

factors, a goal INR

of 1.5–2.0 may be

reasonable starting ≥3

mo after surgery

IIb/B

Bioprosthetic AVR

2–3 for ≥ 3 mo (and up to

6 mo if low bleed risk)

IIa/B

Aspirin 81 mg daily

may be considered

if indicated for

antiplatelet and

bleeding risk low

IIb/B