Mechanical Valve INR Target — EECC MCQ

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EasyValvular Heart DiseaseMechanical Valve INR TargetEECC

A 58-year-old man with a mechanical aortic valve (St Jude Medical, 23 mm) and no other risk factors is maintained on warfarin. What is the recommended target INR according to current guidelines?

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Correct answer: B — 2.5 (range 2.0-3.0)

The 2025 ESC/EACTS VHD Guidelines determine the target INR for mechanical prosthetic valves based on prosthesis thrombogenicity and patient risk factors. A bileaflet mechanical valve in the aortic position (low thrombogenicity, e.g. St Jude) with no additional risk factors (AF, prior thromboembolism, severe LV dysfunction, hypercoagulable state, mitral position) has a target INR of 2.5 (range 2.0-3.0). The mitral position or presence of risk factors increases the target to 3.0 (range 2.5-3.5). DOACs are absolutely contraindicated with mechanical valves (RE-ALIGN trial terminated early due to excess thromboembolism with dabigatran).

Reference: ESC/EACTS (2025): Guidelines for the Management of Valvular Heart Disease