A 45-year-old man received a bileaflet mechanical aortic valve prosthesis. He has no other thromboembolic risk factors. What is the recommended target INR range?
- A 1.5 to 2.0
- B 2.0 to 3.0 ✓
- C 2.5 to 3.5
- D 3.0 to 4.0
Correct answer: B. 2.0 to 3.0
Explanation
A bileaflet mechanical valve in the aortic position without additional risk factors carries a lower thrombotic risk than a mitral prosthesis, so the target INR is 2.5 with an acceptable range of 2.0 to 3.0. Mechanical mitral valves, older caged-ball valves, prior stroke, atrial fibrillation, or hypercoagulable states raise the target to 3.0 with a range of 2.5 to 3.5. An INR below 2.0 is inadequate for any mechanical valve.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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