Mechanical AVR INR Target — EECC MCQ

Correct answer: D — INR target 2.0-3.0 (or 2.5 as the target) for a modern bileaflet aortic mechanical valve without additional risk factors; higher targets (2.5-3.5) are used for older-generation valves, mitral position, or additional thrombotic risk factors

INR targets for mechanical valves are determined by valve thrombogenicity (position + valve type) AND patient risk factors per the 2025 ESC VHD Guidelines: (1) Valve thrombogenicity: LOW (bileaflet, Medtronic Hall tilting disc in aortic position) → INR 2.0-3.0; MEDIUM → INR 2.5-3.5; HIGH (Starr-Edwards ball-and-cage, all mitral mechanical valves) → INR 2.5-3.5 or 3.0-4.0. (2) Patient factors that increase target by 0.5: AF, previous thromboembolism, LV dysfunction, hypercoagulable state. This patient with a bileaflet (St Jude) aortic valve and no risk factors is in the lowest category: INR 2.0-3.0 (target 2.5). Self-monitoring of INR improves TTR. DOACs remain ABSOLUTELY CONTRAINDICATED for all mechanical valves (RE-ALIGN trial).

Reference: ESC/EACTS (2025): VHD Guidelines