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Updated: Sep 16, 2025
14:14
Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
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A Higher-Than-Standard-Intensity International Normalized Ratio Goal for Patients Undergoing Mechanical Aortic Valve
Myung-Rho Kim1, Taha Shaikh1, Shawn Wang2
1Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, Las Vegas, United States.
JMIR Research Protocols
|July 10, 2025
Summary
This systematic review evaluates higher international normalized ratio (INR) goals for patients with mechanical aortic valve replacement (MAVR) and additional risk factors. It aims to optimize anticoagulation therapy, balancing thrombosis prevention and bleeding risk.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Clinical Research Methodology
Background:
- Mechanical aortic valve replacement (MAVR) necessitates lifelong anticoagulation with vitamin K antagonists to prevent valve thrombosis.
- Current guidelines suggest INR 2.5 for MAVR without risk factors and INR 3.0 for those with additional thromboembolic risks.
- Evidence for optimal anticoagulation intensity in high-risk MAVR patients remains limited.
Purpose of the Study:
- To systematically review and meta-analyze the safety and efficacy of higher-intensity INR goals (>3.0) versus standard-intensity goals (approx. 2.5).
- To assess outcomes in patients with MAVR and additional thromboembolic risk factors.
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA 2020 guidelines.
- Literature search of PubMed, Embase, and Cochrane Library for studies published before December 18, 2024.
- Inclusion of RCTs, cohort, and follow-up studies of adult MAVR patients on warfarin, stratified by risk factors.
Main Results:
- Synthesis of existing data comparing risks and benefits of intensified anticoagulation in high-risk MAVR patients.
- Quantitative comparison of thromboembolic events and bleeding complications between different INR goal strategies.
- Scheduled data analysis and manuscript preparation for July-August 2025.
Conclusions:
- This review will provide crucial evidence for INR management in high-risk MAVR patients.
- Findings may inform future clinical guideline updates for anticoagulation therapy.
- The study aims to optimize the balance between preventing thromboembolism and minimizing bleeding risk.
Keywords:
CoumadinMAVRanticoagulationinternational normalized ratiomechanical aortic valve replacementthromboembolic risk factorsthromboembolismvitamin K antagonistwarfarinMore Related Videos
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