Table 28. Diagnosis and Anticoagulation for Prosthetic
Valves (cont'd)
Recommendations COR LOE
Antithrombotic erapy (cont'd)
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 with either IV UFH or SC LMWH
is recommended during the time interval when the INR is
subtherapeutic preoperatively in 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.
I C
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
37
