INR goals for heart valves Flashcards

antithrombotic therapy and duration and INR goals based on certain criteria

1
Q

All mechanical heart valves need to have:

A

ASA 75-100 mg daily with warfarin (in aortic and mitral mechanical valves)

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2
Q

Goal INR for warfarin with aortic mechanical heart valve

A

INR 2-3 if no risk factors are present

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3
Q

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)

A

INR 2.5-3.5

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4
Q

When do we aim for a INR goal between 2.5-3.5?

A

mitral valve replacement
mechanical aortic valve replacement with risk factors
1st THREE months after aortic valve replacement (weak recommendation)

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5
Q

Why do we have a higher goal for INR w/ warfarin w/ patients who have a mitral valve replacement ?

A

Because 2x risk of stroke with mitral than aortic valve replacement.

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6
Q

what are the risk factors that make a mechanical aortic valve high risk and therefore require a higher INR goal?

A
  • atrial fib,
  • severe left ventricular dysfunction EF<30%,
  • prior VTE,
  • presence of hypercoaguable state.
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7
Q

All mechanical mitral valves INR goal should be:

A

2.5-3.5 because they are all at higher risk for thrombosis

bioprosthetic valves can have INR 2-3

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8
Q

pt has bioprosthetic mitral valve. How long is anticoagulation and what is the goal INR?

A

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

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9
Q

prophylaxis with mechanical and prosthetic heart valves is no longer recommended in:

A

GU and GI procedures (colonoscopy and TURP or prostate biopsy)

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10
Q

prophylaxis with mechanical heart valve is necessary for:

A

dental procedures, invasive respiratory tract procedures (bronchoscopy)

procedures involving infected skin, skin structures or MSK tissue

  • amoxicillin
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11
Q

all pts regardless of mechanical or prosthetic valve or not need to get:

A

antibiotic prophylaxis for Gram negative enteric bacteria prior to TURP or transurethral resection of prostate

tx with ciprofloxacin, or bactrim.

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