Anticoagulation Service For Health Professionals

Anticoagulation for Mechanical Prosthetic Heart Valves

Notes:
1. These indications and recommended intensities of treatment are derived from the Seventh American College of Chest Physicians Consensus Conference (2004).
2. For most indications a therapeutic range of 2.0 to 3.0 is recommended. A higher INR range of 2.5 to 3.5 is recommended for parents with mechanical prosthetic valves and post myocardial infarction and for some patients with antiphospholipid syndrome and a history of thrombosis

Anticoagulation for Mechanical Prosthetic Heart Valves
American College of Chest Physicians Guidelines

Patient Characteristics Recommendation
Bileaflet mechanical valve in the aortic position, left atrium of normal size, NSR, normal ejection fraction Goal INR 2.5; range, 2.0-3.0
Tilting disk valve or bileaflet mechanical valve in the mitral position Goal INR 3.0; range, 2.5-3.5
CarboMedics bileaflet valves or Medtronic Hall tilting disk mechanical valve in the aortic position, normal LA, and SR Goal INR 2.5; range, 2.0-3.0
Bileaflet mechanical aortic valve and AF Goal INR 3.0; range, 2.5-3.5
Caged ball or caged disk valves

Goal INR 3.0; range 2.5-3.5; and aspirin therapy (80-100 mg/d)

Additional risk factors Goal INR 3.0; range, 2.5-3.5; and aspirin therapy (81mg/d)
Systemic embolism, despite adequate therapy with oral anticoagulants Goal INR 3.0; range 2.5-3.5; and aspirin therapy (81mg/d)
Alternative: goal INR 2.5; range, 2.0-3.0; and aspirin therapy (80-100mg/d)