INR goals for heart valves Flashcards
antithrombotic therapy and duration and INR goals based on certain criteria
All mechanical heart valves need to have:
ASA 75-100 mg daily with warfarin (in aortic and mitral mechanical valves)
Goal INR for warfarin with aortic mechanical heart valve
INR 2-3 if no risk factors are present
Goal INR for warfarin with mitral mechanical valve or aortic valve with risk factors
or in 1st THREE months of aortic valve replacement (weak recommendation)
INR 2.5-3.5
When do we aim for a INR goal between 2.5-3.5?
mitral valve replacement
mechanical aortic valve replacement with risk factors
1st THREE months after aortic valve replacement (weak recommendation)
Why do we have a higher goal for INR w/ warfarin w/ patients who have a mitral valve replacement ?
Because 2x risk of stroke with mitral than aortic valve replacement.
what are the risk factors that make a mechanical aortic valve high risk and therefore require a higher INR goal?
- atrial fib,
- severe left ventricular dysfunction EF<30%,
- prior VTE,
- presence of hypercoaguable state.
All mechanical mitral valves INR goal should be:
2.5-3.5 because they are all at higher risk for thrombosis
bioprosthetic valves can have INR 2-3
pt has bioprosthetic mitral valve. How long is anticoagulation and what is the goal INR?
need 3 months of warfarin with goal for 2-3 with bioprosthetic valve
if mechanical mitral valve need INR goal of 2.5-3.5
prophylaxis with mechanical and prosthetic heart valves is no longer recommended in:
GU and GI procedures (colonoscopy and TURP or prostate biopsy)
prophylaxis with mechanical heart valve is necessary for:
dental procedures, invasive respiratory tract procedures (bronchoscopy)
procedures involving infected skin, skin structures or MSK tissue
- amoxicillin
all pts regardless of mechanical or prosthetic valve or not need to get:
antibiotic prophylaxis for Gram negative enteric bacteria prior to TURP or transurethral resection of prostate
tx with ciprofloxacin, or bactrim.