What is the recommended antithrombotic regimen for patients with mechanical prosthetic heart valves?
In patients with mechanical prosthetic heart valves, effective antithrombotic therapy requires continuous effective warfarin anticoagulation with an INR in the target range. ACC/AHA guidance on the selection of the most appropriate antithrombotic regimen in patients with mechanical heart valves has been published in separate guidelines. Anticoagulation with warfarin to achieve an INR of 2.5 is typically recommended for patients with a mechanical bileaflet or current-generation single-tilting-disk aortic valve replacement and no risk factors for thromboembolism. However, patients with an aortic mechanical prosthesis who have a history of ischemic stroke or TIA are at higher risk of thromboembolic complications, and it is recommended to maintain the INR at a higher target of 3.0 (range, 2.5 3.5) or to add aspirin 75