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Mechanical Prosthetic Heart Valves

Systemic anticoagulation with a target INR of 2.5 (range 2.0 - 3.0) is recommended in the following circumstances:
  • Valves in the aortic position


Systemic anticoagulation with a target INR of 3.0 (range 2.5 - 3.5) is recommended in the following circumstances:

  • Valves in the mitral position
Systemic anticoagulation with a target INR of 3.0 (range 2.5 - 3.5) + ASA (75-100 mg) is recommended in the following circumstances:
  • Presence of other risk facors such as AF, previous MI, left atrial enlargement and reduced LV function
  • Caged disk or caged ball type valve
  • Occurence of an embolic event despite a therapeutic INR

If systemic anticoagulation has to be stopped start therapy with:
  • LMWH or -ASA (75-100 mg)

Tissue Prosthetic Heart Valves

 

Systemic anticoagulation with a target INR of 2.5 (range 2.0 - 3.0) is recommended:

  • For the first 3 months after valve placement in the mitral or aortic position
  • For 3-12 months in patients with a bioprosthetic valve and a history of a systemic embolism 
  • Indefinitely in patients with atrial fibrilation
  • Indefinitely in patients with a left atrial appendage thrombus at the time of surgery

 

ASA 75-100 mg/daily is appropriate in the following circumstances:

  • For patients in sinus rhythm with a prosthetic valve in the aortic position (in place of systemic anticoagulation during the first 3 months)
  • Long term in patients with bioprosthetic valves and in sinus rhythm
 Mitral Valve Prolapse         

Systemic anticoagulation is not recommended in the absence of AF, TIA's or embolic events.

 

Long term antiplatelet therapy with ASA (50-162 mg) for unexpalined TIA's.

 

Systemic anticoagulation with a target INR of 2.5 (range 2.0 - 3.0) is recommended for embolic events or recurrent TIA's despite antiplatelet therapy.

Rheumatic Mitral Valve Disease

Systemic anticoagulation is not recommended:
  • Sinus rhythm and an absence of a previous embolic event
  • Sinus rhytm with a left atrial diameter of less than 5.5 cm

Systemic anticoagulation with a target INR of 2.5 (range 2.0-3.0) is recommended in the following circumstances:
  • Atrial fibrillation or a previous embolic event -a left atrial diameter of 5.5 cm

Systemic anticoagulation with a target INR of 2.5 (range 2.0-3.0) plus ASA (or clopidogrel or dipyridamole in ASA allergic patient) is recommended in the following circumstances:
  • Embolic event occuring while systemically anticaogulated

 

 Aortic Atheroma

Systemic anticoagulation with a target INR of 2.5 (range 2.0-3.0) is recommended in the following circumstance:
 
  • Presence of a mobile atheroma greater or equal to 4 mm
  Endocarditis

In patients with mechanical prosthetic valves, anticoagulation should be continued in the absence of contraindications (e.g. IC bleed)

Systemic therapy with heparin is recommendd in the following circumstances: 
  • Patients with non bacterial endocarditis and pulmonary or systemic embolism
  • Patients with non bacterial endocarditis and a disseminated malignancy or debilitating disease







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