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  • Indications
  • Patients With Prosthetic Valves

Acenocoumarol in Patients With Prosthetic Valves

In patients with prosthetic valves, anticoagulants are widely employed to prevent thromboembolic complications. Acenocoumarol has been shown to be effective for thromboprophylaxis in these patients.72,73

Recommendations for anticoagulant therapy in prosthetic heart valves are as follows74:

Mechanical prosthetic valves

  1. For St. Jude valves in the aortic position, a target international normalized ratio (INR) of 2.5 (2.0 to 3.0) is recommended (Grade 1A).
  2. For patients with mechanical prostheses and additional risk factors such as atrial fibrillation (AF), myocardial infarction, left ventricular hypertrophy, endocardial damage or low ejection fraction, a target INR of 3.0 (2.5-3.5) is recommended, combined with low-dose aspirin (80 to 100 mg/day) (Grade 1C).
  3. For patients with mechanical prostheses with a history of thromboembolism despite a therapeutic INR, 80 to 100 mg/day aspirin in addition to vitamin K antagonists (VKAs) is recommended, with a target INR of 3.0 (2.5-3.5).
  4. For patients in whom VKAs must be discontinued, low-molecular-weight heparin is recommended in non‐pregnant patients and the dose should be adjusted in pregnant patients with monitoring of factor Xa (Grade 1C).

Bioprosthetic valves

  1. Mitral position: patients should be treated with VKAs for the first 3 months after valve insertion (Grade 1C).
  2. Aortic position: patients should be treated with VKAs for the first 3 months after valve insertion (Grade 2C).
  3. In patients with bioprosthetic valves in aortic or mitral position, a target INR of 2.5 (2.0-3.0) is recommended for the first 3 months after valve insertion (Grade 1C).
  4. VKAs together with heparin (low-molecular-weight or unfractionated) is recommended until the INR is stable at therapeutic levels for 2 consecutive days (Grade 2C).
  5. For patients with bioprosthetic valves who have a history of systemic embolism, VKAs are recommended for 3 to 12 months (Grade 1C).
  6. In patients with bioprosthetic valves who have evidence of a left atrial thrombus at surgery, VKAs are recommended with a target INR of 2.5 (2.0-3.0) (Grade 1C).
  7. In patients with bioprosthetic valves who have AF, long‐term treatment with VKAs is recommended, with a target INR of 2.5 (range, 2.0 to 3.0) (Grade 1C).
  8. For patients with bioprosthetic valves who are in sinus rhythm and not covered by the above alternatives, long‐term therapy with aspirin, 80 to 100 mg/d, is recommended (Grade 1C).