What is the most appropriate choice of anticoagulant following valve-replacement surgery in which a bioprosthetic valve was used?—WALTER BUSSEY, PA-C, MPAS, Council Bluffs, Iowa

The American College of Chest Physicians (ACCP) Evidence-Based Clinical Practice Guidelines include various recommendations for anticoagulation therapy following bioprosthetic aortic and mitral valve replacement. For patients with bioprosthetic heart valves, low-dose aspirin is the primary choice of anticoagulation. Vitamin K antagonist therapy is recommended in patients with additional risk factors for thromboembolism.

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Carefully assess each patient with an eye toward risks and benefits. Factors to consider include atrial fibrillation, a history or risk of bleeding, previous systemic embolism or left atrial thrombus, left atrial enlargement, and previous stroke or transient ischemic attack.

Consult the ACCP guidelines (Chest. 2008;133[6 Suppl]: 593S-629S) to find the most suitable anticoagulation therapy for each patient.—Debra Kleinschmidt, PhD, PA (141-9)