How should anticoagulation be managed in patients with mechanical heart valves?

In patients with mechanical heart valves, anticoagulation management is critical to prevent thromboembolic complications, particularly stroke. The recommended target international normalized ratio (INR) for these patients generally falls within the range of 2.5 to 3.0. This range strikes a balance between minimizing the risk of thrombosis at the valve site and preventing excessive bleeding, which can occur if anticoagulation is too intense.

Mechanical heart valves have a tendency to create turbulent blood flow, which increases the chance of clot formation. Therefore, the INR target is slightly elevated compared to that of patients with other anticoagulation needs. Maintaining the INR within the 2.5 to 3.0 range effectively reduces the risk of valve thrombosis while keeping patients safe from bleeding complications that occur with higher INRs.

In contrast, lower INR targets may not provide sufficient anticoagulation protection against thrombus formation, while higher targets can lead to increased risk of bleeding, particularly in a population that may already have significant comorbidities. Therefore, the 2.5 to 3.0 target is considered optimal for these patients and is reflected in the current anticoagulation guidelines for individuals with mechanical heart valves.