A patient with a mechanical heart valve needs to receive antithrombotic therapy.


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


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