Table 5. Target INR for Heart Valve Prostheses

Adapted from Antithrombotic Therapy in Valvular Heart Disease—Native and Prosthetic: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Deeb N. Salem, Paul D. Stein, Amin Al-Ahmad, Henry I. Bussey, Dieter Horstkotte, Nancy Miller, and Stephen G. Pauker
Chest 126: 457S-482S. and ACC/AHA Pocket Guidelines. Management of Patients with Valvular Heart Disease, 2006.

.	INR	DURATION	ALTER NATIVE	ADD
GENERAL APPROACH *	.
Mechanical prostheses(1)	2.0-3.0	Indefinite	.	May add ASA 80
Mechanical prostheses, others	2.5-3.5	Indefinite	.	May add ASA 80
Mechanical prostheses(3)	2.5-3.5	Indefinite	.	Add ASA 80
Mechanical prostheses, with RF(2)	2.5-3.5	Indefinite	.	Add ASA 80
.
AORTIC VALVE *
AV prostheses, bileaflet*, no RF(2)	2.0-3.0	Indefinite	.	May add ASA 80
AV prostheses, bileaflet*, with RF(2)	2.5-3-5	Indefinite	.	Add ASA 80
AV prostheses, others, no RF(2)	2.5-3.5	Indefinite	.	May add ASA 80
AV prostheses, others, with RF(2)	2.5-3.5	Indefinite	.	Add ASA 80
.
AV bioprostheses, 1st 3 months	2.5-3.5	3 months	ASA 325	.
-- After 3 months	ASA 80	Indefinite	.	.
-- After 3 months, with RF(2)	2.0-3.0	Indefinite	.	May add ASA 80
.
MITRAL VALVE *	.
MV prostheses, mechanical	2.5-3.5	Indefinite	.	May add ASA 80
.
MV bioprostheses, 1st 3 months	2.5-3.5	3 months	.	May add ASA 80
-- After 3 months	ASA 80	Indefinite	.	May add ASA 80
-- After 3 months, with RF(2)	2.5-3.5	Indefinite	.	May add ASA 80

For Pacific-Asian population, The INR range of 2.0-3.0 and 2.5-3.5 may be substituted with INR range of 1.6-2.6 and 2.0-3.0 respectively.

• * = Warfarin can be started the day after prosthetic valve replacement. UFH or LMWH should be started about 2 days post surgery (when surgical bleeding has been completely controlled) and condtinue until INR reaches therapeutic level for 2 consecutive days.
• (1) = In aortic position.: St. Jude Medical bileaflet, CarboMedics bileaflet, Medtronic-Hall tilting mono disc, Omnicarbon mono tilting disc, and Sorin bileaflet.
• (2) = Risk factors: History of TIAs, CVA, systemic emboli, severe LV systolic dysfunction, recurrent CHF.
• (3) = Caged ball or caged disk valve.