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