Treatment Bioprosthetic
ÎIn patients with aortic bioprosthetic valves who are in sinus rhythm and have no other indication for VKA therapy, the ACCP suggests aspirin (50-100 mg/d) over VKA therapy in the first 3 months (2-C).
ÎIn patients with transcatheter aortic bioprosthetic valves, the ACCP suggests aspirin (50-100 mg/d) plus clopidogrel (75 mg/d) over VKA therapy and over no antiplatelet therapy in the first 3 months (2-C).
ÎIn patients with a bioprosthetic valve in the mitral position, the ACCP suggests VKA therapy (target INR 2.0-3.0) over no VKA therapy for the first 3 months after valve insertion (2-C).
ÎIn patients with bioprosthetic valves in NSR, the ACCP suggests aspirin therapy over no aspirin therapy after 3 months postoperative (2-C).
Mechanical
ÎIn patients with mechanical heart valves, the ACCP suggests bridging with UFH (prophylactic dose) or LMWH (prophylactic or therapeutic dose) over IV therapeutic UFH until stable on VKA therapy (2-C).
ÎIn patients with mechanical heart valves, the ACCP recommends VKA therapy over no VKA therapy for long-term management (1-B).
ÎIn patients with a mechanical aortic valve, the ACCP suggests VKA therapy with a target of 2.5 (range 2.0-3.0) over lower targets (2-C).
ÎIn patients with a mechanical aortic valve, the ACCP recommends VKA therapy with a target of 2.5 (range 2.0-3.0) over higher targets (1-B).
ÎIn patients with a mechanical mitral valve, the ACCP suggests VKA therapy with a target of 3.0 (range 2.5-3.5) over lower INR targets (2-C).
ÎIn patients with mechanical heart valves in both the aortic and mitral position, the ACCP suggests target INR 3.0 (range 2.5-3.5) over target INR 2.5 (range 2.0-3.0) (2-C).
ÎIn patients with a mechanical mitral or aortic valve at low risk of bleeding, the ACCP suggests adding, over not adding, an antiplatelet agent such as low-dose aspirin (50-100 mg/d) to the VKA therapy (1-B).
Remark: Caution should be used in patients at increased bleeding risk, such as history of gastrointestinal bleeding.
ÎFor patients with mechanical aortic or mitral valves the ACCP recommends VKA over antiplatelet agents (1-B).
Valve Repair
ÎIn patients in NSR undergoing mitral valve repair with a prosthetic band, the ACCP suggests the use of antiplatelet therapy for the first 3 months over VKA therapy (2-C).
ÎIn patients undergoing aortic valve repair, the ACCP suggests aspirin at 50-100 mg/d over VKA therapy (2-C).
