Patient handout

Prosthetic heart valve — chronic management

PRODUCTION

1. Your condition

This handout is for prosthetic heart valve — chronic management. Your care team identified this based on: mechanical / bioprosthetic / tavr valve — surveillance visit.

Other reasons your team may use this plan: sub-/supra-therapeutic inr on mechanical-valve vka; new prosthetic murmur / dyspnea / heart failure; upcoming surgery/procedure — bridging decision.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
warfarin	INR-guided	PO	once daily	Mechanical AVR bileaflet no risk → INR 2.5 (2.0–3.0); AVR with risk / older valve → 3.0; mechanical MVR → 3.0 (2.5–3.5). RE-ALIGN: dabigatran caused excess thromboembolism + bleeding — DOAC contraindicated (2020 ACC/AHA VHD)
aspirin	75–100 mg	PO	once daily	Low-dose aspirin add-on reasonable with VKA if low bleeding risk (2020 ACC/AHA VHD)

Plan: Prosthetic valve antithrombotic + complication management (2020 ACC/AHA VHD; 2021 ESC/EACTS VHD)

3. When to call your provider

Contact your care team if any of the following happen:

Obstructive valve thrombosis / acute prosthetic dysfunction → ED emergency — 2020 ACC/AHA VHD
New regurgitation + hemolysis/HF → paravalvular-leak intervention — 2020 ACC/AHA VHD
Fever/bacteremia + prosthesis → PVE workup, route to IE engine — 2020 ACC/AHA VHD

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Obstructive prosthetic valve thrombosis (high gradients, reduced leaflet motion, HF/shock) — EMERGENCY: fibrinolysis vs surgery — 2020 ACC/AHA VHD(life-threatening)
DOAC prescribed for a mechanical valve — switch to VKA immediately (RE-ALIGN: excess thromboembolism + bleeding) — 2020 ACC/AHA VHD
Pregnancy with a mechanical valve — warfarin most effective but teratogenic 1st trimester; LMWH (anti-Xa guided) alternative; mWHO III–IV; multidisciplinary — ESC 2018 Pregnancy
Bioprosthetic SVD (rising gradient / new regurgitation, typically >5–10 yr) — valve-in-valve TAVR or redo surgery — 2020 ACC/AHA VHD
Fever/bacteremia/new regurgitation with a prosthesis — prosthetic valve endocarditis: route to IE engine, early-surgery indications — 2020 ACC/AHA VHD(life-threatening)
Paravalvular leak with hemolytic anemia or HF — percutaneous closure or reoperation — 2020 ACC/AHA VHD

5. Follow-up

Lifelong; pregnancy + procedure planning; SVD watch for bioprosthesis

6. Sources

Guideline: 2020 ACC/AHA VHD Guideline + 2021 ESC/EACTS VHD Guideline