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Editorials |

Balancing Thromboembolism and Bleeding Risks: Insights From Anticoagulation for Prosthetic Heart Valves

Kok-Hoon Tay, MBBS; Deirdre A. Lane, PhD; Gregory Y. H. Lip, MD
Author and Funding Information

Correspondence to: Gregory Y. H. Lip, MD, City Hospital, Haemostasis, Thrombosis, and Vascular Biology Unit, Dudley Rd, Birmingham, B18 7QH, UK; e-mail: g.y.h.lip@bham.ac.uk

Affiliations: Drs. Tay, Lane, and Lip are affiliated with the University Department of Medicine, City Hospital.


Financial/nonfinancial disclosures: The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(6):1451-1452. doi:10.1378/chest.09-1187
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Extract

Thromboembolic and bleeding complications are the most frequent valve-related complications after mitral valve replacement (MVR), accounting for approximately two-thirds of all valve-related morbidity.1 Reported data for serious bleeding complications vary from 0.5% to 6.3% per patient-year.2 The eighth edition of the American College of Chest Physicians Evidence-Based Clinical Practice Guidelines3 recommends anticoagulation to achieve a target international normalized ratio (INR) of 3.0, with a target range of 2.5 to 3.5 for mechanical mitral valves, which is higher than the INR for aortic valve replacement (target INR, 2.5; target range, 2.0 to 3.0) if there are no coexisting complicating factors. However, if there are additional atherosclerotic vascular risks or atrial fibrillation (AF), low-dose aspirin (50 to 100 mg daily) is recommended as an “add-on” to life-long anticoagulation therapy, unless there is a compelling indication not to, such as in elderly patients (ie, patients > 80 years old) who are deemed to be at high risk of bleeding.3

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