Anticoagulation antiplatelet therapy-prosthetic-heart-valves

(Circ 2021;143:e72)

• Mechanical: warfarin (not DOAC), INR 3 or 2.5 if low-risk mech AVR (none of following: prior thromboembolism, AF, EF <30–35%, hypercoagulable). If thrombosis, ↑ intensity (eg, INR 2–3 → 2.5–3.5; 2.5–3.5 → 3.5–4.5; or + ASA if not on)
• Bioprosthetic: Surgical: ASA (75–100 mg/d) or warfarin INR 2.5 ×3–6 mo, then ASA (75–100 mg/d). DOAC reasonable alternative to warfarin if indication for anticoag (NEJM 2020;383:2117). TAVI: ASA 75–100 mg/d. If need OAC, then no antiplt (vide supra). Periprocedural “Bridging” of Anticoagulation in Pts with Mechanical Valve(s)