INR goals for heart valves

Question 1

All mechanical heart valves need to have:

Answer 1

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

Question 2

Goal INR for warfarin with aortic mechanical heart valve

Answer 2

INR 2-3 if no risk factors are present

Question 3

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)

Answer 3

INR 2.5-3.5

Question 4

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

Answer 4

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

Question 5

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

Answer 5

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

Question 6

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

Answer 6

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

Question 7

All mechanical mitral valves INR goal should be:

Answer 7

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

bioprosthetic valves can have INR 2-3

Question 8

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

Answer 8

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

Question 9

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

Answer 9

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

Question 10

prophylaxis with mechanical heart valve is necessary for:

Answer 10

dental procedures, invasive respiratory tract procedures (bronchoscopy)

procedures involving infected skin, skin structures or MSK tissue

• amoxicillin

Question 11

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

Answer 11

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

tx with ciprofloxacin, or bactrim.