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Anticoagulation Management Service For Health Professionals

Anticoagulation for Mechanical Prosthetic Heart Valves

Notes:
1. These indications and recommended intensities of treatment are derived from the Eighth American College of Chest Physicians Consensus Conference (2008).
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

* duration indefinite, unless otherwise indicated
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: atrial fibrillation/flutter, anteroapical MI, left artrial enlargement, low EF, hypercoalgulable state 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)
Bioprosthetic valve (mitral position) Goal INR 2.5: range, 2.0 - 3.0; duration 3 months and then aspirin therapy (81mg/d)

Revised 6/15/2009