42
Prosthetic Valves
Table 26. Diagnosis and Anticoagulation for Prosthetic
Valves (cont'd)
Recommendations COR LOE
Antithrombotic erapy (cont'd)
A lower target INR of 1.5 to 2.0 may be reasonable in patients
with mechanical On-X AVR and no thromboembolic risk
factors. (New recommendation for 2017)
IIb B-R
Anticoagulation with a VK A to achieve an INR of 2.5 may
be reasonable for at least 3 months aer TAVR in patients at
low risk of bleeding. (New recommendation for 2017)
IIb B-R
Clopidogrel 75 mg daily may be reasonable for the first
6 months aer TAVR in addition to lifelong ASA
75–100 mg daily.
IIb C
Anticoagulant therapy with oral direct thrombin inhibitors
or anti-Xa agents should NOT be used in patients with
mechanical valve prostheses.
III: Harm B
Bridging erapy
Continuation of VKA anticoagulation with a therapeutic
INR is recommended in patients with mechanical heart valves
undergoing minor procedures (such as dental extractions or
cataract removal) where bleeding is easily controlled.
I C
Temporary interruption of VKA anticoagulation, without
bridging agents while the INR is subtherapeutic, is
recommended in patients with a bileaflet mechanical AVR
and no other risk factors for thrombosis who are undergoing
invasive or surgical procedures.
I C
Bridging anticoagulation therapy during the time interval
when the INR is subtherapeutic preoperatively is reasonable
on an individualized basis, with the risks of bleeding weighed
against the benefits of thromboembolism prevention, for
patients who are undergoing invasive or surgical procedures
with a 1) mechanical AVR and any thromboembolic risk
factor, 2) older generation mechanical AVR, or 3) mechanical
MVR. (Modified recommendation for 2017)
IIa C-LD
Administration of fresh frozen plasma or prothrombin
complex concentrate is reasonable in patients with mechanical
valves receiving VKA therapy who require emergency
noncardiac surgery or invasive procedures.
IIa C
Administration of fresh frozen plasma or prothrombin
complex concentrate is reasonable in patients with mechanical
valves and uncontrollable bleeding who require reversal of
anticoagulation.
IIa B
