Table 4.

Anticoagulation related issues in patients with prosthetic heart valves

Type of PHV	Anticoagulant/ Antiplatelet	Target	Bridging Needed	Technique of bridging	Monitoring during bridging	Drug Dosage
Mechanical bileaflet/single tilting AVR & no risk factor for TE	VKA	INR-2.5	No			Titrated to effect
Mechanical MVR, AVR (with ball in cage) or with additional risk factor for TE	VKA	INR -3.0	Not for minor surgeries, needed for invasive procedures	Bridging with either i.v. UFH or s.c. LMWH	For UFH, APTT 2.5 to 3.0 times normal, For LMWH, trough factor Xa level >0.6 IU/ml	80 units/kg i.v. bolus followed by 18 units/kg i.v. infusion, or 8000-10,000 units s.c. every 8 hours or 15,000-20,000 units every 12 hours Enoxaparin: 1.0 mg/kg twice daily or 1.5 mg/kg daily, s.c.
Bioprosthetic SAVR/MVR without any other indication for anticoagulation	VKA for 3-6 months,	INR 2.5	Yes, if on VKA therapy			Dalteparin: 100 IU/Kg twice daily or 200 IU/kg daily, s.c. Fondaparinux 5 mg daily (BW <50 kg) & 7.5 mg (BW 50-100 kg), s.c.
	followed by lifelong aspirin		No			75-100 mg daily

TE: Thromboembolism, SAVR: Surgical Aortic Valve Replacement, MVR: Mitral valve replacement, VKA: Oral vitamin K antagonist, i.v.: Intravenous, s.c.: Sub cutaneous, UFH: Unfractionated heparin, LMWH: Low molecular weight heparin, BW- Body weight, IU: International units