Valvular Disease

Question 1

On-X Valve INR goals

Answer 1

2 - 3 for the first 90 days, then 1.5 - 2.0

Question 2

Bioprosthetic Valve Duration

Answer 2

2 - 3 months, at most 6 months before stopping anticoagulation

Question 3

Mechanical valve antithrombotic therapy

Answer 3

warfarin and ASA 81 mg daily indefinitely

Question 4

Bioprosthetic valve antithrombotic therapy

Answer 4

warfarin OR DOAC and ASA 81 mg daily for 3 - 6 months, then ASA 81 mg daily indefinitely

Question 5

TAVR antithrombotic therapy

Answer 5

Clopidogrel + ASA 81 mg daily (DAPT) for 3 - 6 months, then ASA 81 mg daily indefinitely

Question 6

Which DOAC had a greater risk of bleeding for “valvular” Afib?

Answer 6

Rivaroxaban - ROCKET AF

Question 7

What to do if bioprosthetic valve thrombus if clinically unstable?

Answer 7

Surgical repair > thrombolysis

Step up therapy for long term

Question 8

What to do if mechanical valve and pregnancy?

First 36 weeks:
Peripartum:
24 hours before delivery:
12 hours before delivery:
4 - 6 hours before neuraxial anesthesia:
4 - 6 hours after delivery:
5 - 7 days after delivery:

Answer 8

First 36 weeks, start warfarin at low daily dose (less than 5 mg daily) OR LMWH and ASA 81 mg
When peripartum, wean off of warfarin and keep them just on LMWH
24 hours before delivery, stop LMWH
12 hours before delivery, start IV UFH
4-6 hours before neuraxial anesthesia, stop UFH
Post partum:
4 - 6 hours after delivery, start LMWH or UFH
5 - 7 days after delivery, start warfarin

Question 9

Pregnancy LMWH anti-Xa target for mitral valve

For aortic valve

Answer 9

1. 0 - 1.2 for mitral valve

0. 8 - 1.0 for aortic valve