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©2013 UpToDate ® Print Email Ninth ed: ACCP evidence-based clinical practice guidelines: Antithrombotic therapy in patients with bioprosthetic heart valves For the first three months after bioprosthetic mitral valve replacement (MVR), vitamin K antagonist (VKA) therapy (target INR, 2.5;range, 2.0-3.0) is suggested over no VKA therapy For the first three months after surgical bioprosthetic aortic valve replacement (AVR) in patients who are in sinus rhythm and have no other indication for VKA therapy, aspirin (50 to 100 mg/day) is suggested over VKA therapy. For the first three months after transcatheter aortic bioprosthetic valve implantation, aspirin (50 to 100 mg/d) plus clopidogrel (75 mg/d) is suggested over VKA therapy and over no antiplatelet therapy. For the first three months after mitral valve repair with an annular ring in patients who are in sinus rhythm, antiplatelet therapy is suggested over VKA therapy. After the first three months following bioprosthetic valve replacement in patients in normal sinus rhythm, aspirin therapy is suggested over no aspirin therapy. In patients undergoing aortic valve repair, aspirin (50 to 100 mg/d) is suggested over VKA therapy. Data from Whitlock RP, Sun JC, Fremes SE, Rubens FD, Teoh KH. Antithrombotic and thrombolytic therapy for valvular disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141:e576S.