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©2013 UpToDate ® Print Email ACC/AHA guideline summary: Antithrombotic therapy in patients with mechanical heart valves Class I - There is evidence and/or general agreement that antithrombotic therapy is indicated in patients with mechanical heart valves in the following settings: • Warfarin to achieve a goal INR of 2.0 to 3.0 after: 1. Aortic valve replacement (AVR) with bileaflet mechanical or Medtronic Hall valves if no risk factors* are present. • Warfarin to achieve a goal INR of 2.5 to 3.5 after: 1. AVR with bileaflet mechanical or Medtronic Hall valves if risk factors* are present. 2. AVR with Starr-Edwards or disc valves other than Medtronic Hall if no risk factors* are present. 3. Mitral valve replacement (MVR) with any mechanical valve. • Role of aspirin: 1. After AVR or MVR in patients who cannot take warfarin, at a dose of 75 to 325 mg/day. 2. At a dose of 75 to 100 mg/day in addition to warfarin in all patients with mechanical valves and in patients with biological valves who have risk factors*. Class IIa - The weight of evidence or opinion is in favor of the usefulness of antithrombotic therapy in patients with mechanical heart valves in the following setting: • In the first three months after AVR, warfarin to achieve a goal INR of 2.5 to 3.5. Class IIb - The weight of evidence or opinion is less well established for the usefulness of antithrombotic therapy in patients with mechanical heart valves in the following setting: • In high-risk patients in whom aspirin cannot be used, clopidogrel (75 mg/day) or warfarin to attain a goal INR of 3.5 to 4.5. * Risk factors include atrial fibrillation, prior thromboembolism, left ventricular dysfunction, 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). Circulation 2008; 118:e523.