Antithrombotic Therapy for a Patient with a Mechanical Heart Valve

 

Antithrombotic regimen:

(1) aspirin 75 to 100 mg per day (an alternative agent is needed if there is aspirin intolerance)

(2) life-long warfarin therapy

 

Indications for targeting an INR of 2.5 to 3.5:

(1) mechanical mitral valve

(2) aortic caged ball or tilting disc

(3) (aortic bileaflet or Medtronic Hall) plus risk factors (see below)

 

Indications for targeting an INR of 2.0 to 3.0:

(1) (aortic bileaflet or Medtronic Hall) without risk factors

 

Risk factors:

(1) atrial fibrillation

(2) history of a thromboembolism

(3) left ventricular ejection fraction < 35%

(4) hypercoagulable state