Cardiovascular Critical Care I

Procedure

Warfarin,

Target INR Range

Class of

Recommendation/

Level of Evidencea

Antiplatelet

Therapy

Class of

Recommendation/

Level of Evidencea

Transcatheter AVR

(TAVR)

2–3 for ≥ 3 mo if low

bleed risk

IIb/B

Alternative

to warfarin:

Clopidogrel 75

mg daily for 6 mo

and aspirin 81 mg

daily. Although the

above are guideline

recommendations,

the POPULAR-

TAVI trial showed

that aspirin

monotherapy

decreased the

incidence of

bleeding and

the composite

of bleeding and

thromboembolic

events compared

with dual

antiplatelet

therapy for 3 mo

(N Engl J Med.

2020;383(15):1447-

1457)

IIb/B

Mechanical MVR

2.5–3.5

I/B

Aspirin 81 mg daily

may be considered

if indicated for

antiplatelet therapy

and bleeding risk

is low

IIb/B

Bioprosthetic

MVR

2–3 for ≥ 3 mo (and up to

6 mo if low bleed risk)

IIa/B

Aspirin 81 mg daily

IIa/B

aAtrial fibrillation, previous thromboembolism, left ventricular dysfunction, or hypercoagulable conditions.

bClass of Recommendations: I = evidence and/or general agreement that a given treatment or procedure is beneficial, useful, effective; II = conflicting evidence and/

or a divergence of opinion about the usefulness/efficacy of the given treatment or procedure; IIa = weight of evidence/opinion is in favor of usefulness/efficacy; IIb =

usefulness/efficacy is less well established by evidence/opinion; III = evidence of general agreement that the given treatment or procedure is not useful/effective and, in

some cases, may be harmful; Levels of Evidence: A = data derived from several randomized clinical trials or meta-analyses; B = data derived from a single randomized

trial or large nonrandomized studies; C = consensus of opinion of the experts and/or small studies, retrospective studies, registries.

cTarget INR 2-3 for the first 3 mo.

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