Choice of valve prosthesis for mitral valve replacement
Mechanical prosthesis is recommended for patients for mitral valve replacement
A. < 35 years
B. < 65 years
C. > 35 years
D. > 65 years
Mechanical prosthesis is recommended for patients <65 years
Bioprosthesis is recommended for patients >70 years or those in whom life expectancy is shorter than the expected bioprosthetic valve durability.
Anticoagulation is required for all currently available mechanical mitral valve prostheses.
Guideline from ACC/AHA in 2008 on anticoagulation for prosthesis is as follows
After aortic valve replacement (AVR) with mechanical prostheses, warfarin is indicated to achieve an INR of 2.0 to 3.0. If the patient has risk factors, warfarin is indicated to achieve an INR of 2.5 to 3.5.
After mitral valve replacement (MVR) with mechanical valve, is indicated warfarin to achieve an INR of 2.5 to 3.5.
After AVR or MVR with a bioprosthesis and no risk factors, aspirin is indicated at 75 to 100 mg per day. With risk factors, warfarin is indicated to achieve an INR of 2.0 to 3.0.
For those patients who are unable to take warfarin, aspirin is indicated with a dose of 75 to 325 mg per day. The addition of aspirin 75 to 100 mg once daily to therapeutic warfarin is recommended for all patients with mechanical heart valves and those patients with biological valves who have risk factors.
|Anticoagulation for prosthesis|
|AVR||INR of 2.0 to 3.0|
|MVR||INR of 2.5 to 3.5|
|AVR or MVR with a bioprosthesis and no risk factors||Aspirin is indicated at 75 to 100 mg per day|
|AVR or MVR with a bioprosthesis and with risk factors,||Warfarin is indicated to achieve an INR of 2.0 to 3.0.|