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Inr normal range mechanical valve8/12/2023 ![]() Non-valvar atrial fibrillation with risk factors Patients with recurrent emboli under adequate anticoagulation No anticoagulation after three monthsĢ.5 for three months. However, treatment with heparin during the procedure is required.Įuropean Society of Cardiology 1995 INR rangeīritish Society of Haematology 1998 INR targetģ.0-3.5 for three months. Patients in sinus rhythm who are undergoing aortic valvuloplasty do not need long term anticoagulant treatment. After the procedure, subcutaneous heparin should be given for 24 hours and oral anticoagulant treatment restarted 24 hours after the procedure in patients with risk factors, especially in the presence of atrial fibrillation or spontaneous echocontrast. ![]() Preferred in those who cannot (or will not) take lifelong anticoagulant therapyĭuring the procedure, intravenous heparin (2000-5000 IU bolus) should be given to all patients immediately after trans-septal catheterisation. Preferred in patients who require lifelong anticoagulant therapy Preferred in older patients with <10-15 years life expectancy Preferred in younger patients with >10-15 years life expectancy Low thrombogenic potential-lifelong anticoagulation is not required Thrombogenic-patients require lifelong anticoagulant therapy Limited life span-10% of homografts and 30% of heterografts fail within10-15 years Mitral valve prolapse per se does not require anticoagulant cover, although sometimes aspirin is recommended because of the association with cerebrovascular events. In the absence of cardiac failure, previous thromboemboli, or heart failure, antithrombotic therapy is not indicated in patients with isolated aortic or tricuspid valve disease. Similarly, in patients with mitral regurgitation treatment is indicated in the presence of congestive cardiac failure, marked cardiomegaly with low cardiac output, and an enlarged left atrium. In these patients a target INR of 2.5 (range 2-3) is recommended. In patients with mitral stenosis in sinus rhythm, treatment is guided by the severity of stenosis, the patient's age, size of the left atrium, and the presence of spontaneous echocontrast or echocardiographic evidence of left atrial appendage thrombus. Oral anticoagulant treatment is indicated in all patients who have established or paroxysmal atrial fibrillation with native valve disease regardless of the nature or severity of the valve disease. ![]() First generation mechanical valves, namely the Starr-Edwards caged ball valve and Bjork-Shiley standard valves, have a high thromboembolic risk single tilting disc valves have an intermediate thromboembolic risk and the newer (second and third generation) bileaflet valves have low thromboembolic risks. However, the intensity of treatment varies according to the type of mechanical prosthesis implanted. For example, mechanical prostheses are more thrombogenic than bioprostheses or homografts, and hence patients with mechanical valves require lifelong anticoagulant therapy. Secondly, the type, number, and location of prostheses implanted must be considered. These factors include age, smoking, hypertension, diabetes, hyperlipidaemia, type and severity of valve lesion, presence of atrial fibrillation, heart failure or low cardiac output, size of the left atrium (over 50 mm on echocardiography), previous thromboembolism, and abnormalities of the coagulation system including hepatic failure. Risk factors that increase the incidence of systemic embolism must be considered when defining the need for starting antithrombotic therapy in patients with cardiac valvar disease and prosthetic heart valves. ![]()
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