Cardiac Valve Replacement - Anticoagulation INR Targets and Antiplatelet by Valve Type


Bioprosthetic valves require at least 3 months (up to 6 mo) of vitamin K antagonist (VKA) with a goal INR 2.5, plus aspirin (ASA) 75-100 mg daily. VKA can be stopped after 3 months, but ASA 75-100 mg daily should be continued lifelong as monotherapy (2017 AHA/ACC VHD Guidelines). Three to six months are required for endothelialization of the bioprosthetic valve. Note: some experts utilize direct oral anticoagulants (DOACs) for bioprosthetic valves since these agents have been studied in patients with chronic atrial fibrillation and a bioprosthetic valve (2017 AHA/ACC VHD Guidelines Section 2.4.3; UpToDate Anticoagulation in Prosthetic Valves ).
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