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©2013 UpToDate ® Print Email ACC/AHA guideline summary: Antithrombotic therapy in patients with bioprosthetic heart valves Class I - There is evidence and/or general agreement that antithrombotic therapy is indicated in patients with bioprosthetic heart valves in the following settings: • Warfarin to achieve a goal INR of 2.0 to 3.0 after: 1. Aortic valve replacement (AVR) if risk factors* are present. 2. MVR with a bioprosthesis if risk factors* are present. • Role of aspirin: 1. After AVR or MVR with no risk factors* at a dose of 75 to 100 mg/day 2. After AVR or MVR in patients with risk factors* who cannot take warfarin, at a dose of 75 to 325 mg/day. 3. In addition to warfarin, in patients with risk factors* at a dose of 75 to 100 mg/day. Class IIa - The weight of evidence or opinion is in favor of the usefulness of antithrombotic therapy in patients with bioprosthetic heart valves in the following setting: • In the first three months after AVR or MVR in patients with no risk factors*, warfarin to achieve a goal INR of 2.0 to 3.0. * Risk factors include atrial fibrillation, prior thromboembolism, severe left ventricular dysfunction (ejection fraction less than 0.30), and a hypercoagulable state. Data from Bonow RO, Carabello BA, Chatterjee K, et al. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2008; 118:e523.