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Rủi ro cao Điều trị INR 2,5 - 3,5 + ASA 80-100mg/day. Van cấy ghép trước khi 1980 trước bệnh thuyên tắc mạch máu nguy cơ rủi ro trung đột quỵ 2% / năm trên warfarin một mình INR 2,5 - 3,5 rủi ro thấp INR 2-3 Bileaflet van động mạch chủ trong điều trị vị trí và phân tầng nguy cơ | Antithrombotic Therapy for Cardiac Disease Table 20.5. Risk stratification and therapy of mechanical valve patients I High Risk Treat to INR 2.5 - 3.5 ASA 80-100mg day. Valve implanted before 1980 Previous embolism Vascular disease Risk of stroke 2 yr on warfarin alone Medium Risk INR 2.5 - 3.5 Low Risk INR 2-3 Bileaflet valve in aortic position Treatment and Risk Stratification of Bioprosthetic Valves AVR or MVR INR 2.5 - 3.5 for 3 months then ASA a fib INR 2-3 hx embolism vascular disease or LA thrombus INR 2.5-3.5 ASA 80 - 100 mg day 147 20 Table 20.6. Risk for embolic events when off anticoagulation Pauker JAMA Aortic Position One Day Two Weeks One Year Ball 0.03 0.44 11 Bjork 0.03 0.38 10 St Jude 0.02 0.21 5 Mitral Position Ball 0.08 1.13 30 Bjork 0.05 0.74 19 St Jude 0.03 0.48 13 in Table 20.6. It is relatively safe for short periods of time to stop anticoagulation. One should avoid large doses of vitamin K greater than 1-2 mg for reversal of warfarin anticoagulation. The higher doses of vitamin K are no more effective than lower doses and when the patient needs to be restarted on warfarin it will take a much longer time to reach a therapeutic prothrombin time when high doses of vitamin K have been used. Bioprosthetic Heart Valves Although the risk is lower bioprosthetic hearts valves still have a definite risk of associated embolization. This is highest immediately after surgery and in patients with bioprosthetic valves who have other risk factors such as atrial fibrillation. Therefore patients with a new bioprosthetic valve should be anticoagulated for 3 months after surgery with warfarin to an INR of 2.0-3.0. Furthermore patients with atrial fibrillation history of embolism or those with left atrial thrombi should be anticoagulated indefinitely with warfarin. Chronic Heart Failure Patients with left ventricular ejection fractions under 30 associated with global dysfunction have rates of stroke of 3-4 year. In addition these patients are also at risk for .