What anticoagulation regimen is best for a patient with a bioprosthetic mitral valve on low-dose aspirin?

The anticoagulation regimen that is most appropriate for a patient with a bioprosthetic mitral valve on low-dose aspirin is a vitamin K antagonist with an INR goal of 2.5. This recommendation is based on guidelines that address the management of patients with mechanical and bioprosthetic heart valves and their thrombosis risk.

For patients with bioprosthetic heart valves, particularly in the mitral position, the use of anticoagulation is generally recommended for a limited duration after surgery. In many cases, it may not be necessary to maintain an INR above 2.5 for long-term anticoagulation, especially when patients are already receiving antiplatelet therapy, such as low-dose aspirin, which helps reduce the risk of thromboembolic events.

Setting an INR goal of 2.5 balances the need for anticoagulation to prevent thrombus formation while minimizing the risk of major bleeding complications. This is especially important in an elderly population or those with other bleeding risks.

In contrast, an INR goal of 3, while effective in certain conditions, may not be necessary or appropriate for bioprosthetic valves, taking into account the increased bleeding risk without significant added benefit. Other options like clopidogrel and