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)