41
Prosthetic Valves
Table 26. Diagnosis and Anticoagulation for Prosthetic Valves
Recommendations COR LOE
Diagnosis
An initial TTE study is recommended in patients aer
prosthetic valve implantation for evaluation of valve
hemodynamics.
I B
Repeat TTE is recommended in patients with prosthetic
heart valves if there is a change in clinical symptoms or signs
suggesting valve dysfunction.
I C
TEE is recommended when clinical symptoms or signs
suggest prosthetic valve dysfunction.
I C
Annual TTE is reasonable in patients with a bioprosthetic
valve aer the first 10 years, even in the absence of a change in
clinical status.
IIa C
Antithrombotic erapy
Anticoagulation with a VKA and International Normalized
Ratio (INR) monitoring is recommended in patients with a
mechanical prosthetic valve.
I A
Anticoagulation with a VKA to achieve an INR of 2.5 is
recommended in patients with a mechanical AVR (bileaflet or
current-generation single tilting disc) and no risk factors for
thromboembolism.
I B
Anticoagulation with a VKA is indicated to achieve an INR
of 3.0 in patients with a mechanical AVR and additional
risk factors for thromboembolic events (AF, previous
thromboembolism, LV dysfunction, or hypercoagulable
conditions) or an older-generation mechanical AVR (such as
ball-in-cage).
I B
Anticoagulation with a VKA is indicated to achieve an INR
of 3.0 in patients with a mechanical MVR.
I B
ASA 75–100 mg daily is recommended in addition to
anticoagulation with a VKA in patients with a mechanical
valve prosthesis.
I A
ASA 75–100 mg daily is reasonable in all patients with a
bioprosthetic aortic or MV.
IIa B
Anticoagulation with a VKA to achieve an INR of 2.5 is
reasonable for at least 3 months and for as long as 6 months aer
surgical bioprosthetic MVR or AVR in patients at low risk of
bleeding. (Modified recommendation for 2017)
IIa B-NR
