What are the ACC/AHA guidelines for the management of patients with valvular heart disease?
The ACC/AHA guidelines for the management of patients with valvular heart disease recommend warfarin (INR, 2.0 to 3.0) after aortic valve replacement with bileaflet mechanical or Medtronic Hall prostheses in patients with no risk factors (Class I; Level of Evidence B), warfarin (INR, 2.5 to 3.5) in patients with risk factors (Class I; Level of Evidence B), and warfarin (INR, 2.5 to 3.5) after mitral valve replacement with any mechanical valve (Class IIa; Level of Evidence C). Additionally, the addition of low-dose aspirin to warfarin is recommended for all patients with mechanical valves (Class IIa; Level of Evidence C). The novel oral anticoagulants (factor Xa inhibitors and direct thrombin inhibitors) are not indicated for the prevention of thromboembolism associated with mechanical heart valves.