Warfarin Dose Adjustment for Prosthetic Heart Valve

Target INR Based on Valve Type and Position

• The American College of Cardiology recommends a target INR of 2.5, with a range of 2.0-3.0, for patients with a mechanical aortic valve, and an INR of 2.07 is within this therapeutic range 1
• For patients with a mechanical mitral valve, the target INR is 3.0, with a range of 2.5-3.5, and an INR of 2.07 is below this therapeutic range 2
• The American Heart Association recommends a target INR of 2.5, with a range of 2.0-3.0, for patients with a bioprosthetic valve within the first 3 months, and an INR of 2.07 is within this range 4

Key Management Principles

• The American College of Cardiology notes that INR fluctuations are associated with increased complications in prosthetic valve patients, and large dose adjustments based on a single INR reading should be avoided 1

Additional Considerations

• The American Heart Association recommends considering the addition of low-dose aspirin (75-100 mg daily) for all mechanical valve patients when bleeding risk is acceptable 2, 4