Thrombotic risk | Indication for anticoagulant therapy | ||
Mechanical heart valve | Atrial fibrillation | VTE | |
High thrombotic risk* | Any mitral valve prosthesis Any caged-ball or tilting disc aortic valve prosthesis Recent (within 6 months) stroke or transient ischemic attack | CHADS2 score 5-6 CHA2DS2-VASc score 7-9 Recent (within 3 months) stroke or transient ischemic attack Rheumatic valvular heart disease | Recent (within 3 months) VTE Severe thrombophilia (eg, deficiency of protein C, protein S, or antithrombin; antiphospholipid antibodies; multiple abnormalities) |
Moderate thrombotic risk | Bileaflet aortic valve prosthesis and 1 or more of the of following risk factors: atrial fibrillation, prior stroke or transient ischemic attack, hypertension, diabetes, congestive heart failure, age >75 years | CHADS2 score 3-4 CHA2DS2-VASc score 4-6 | VTE within the past 3 to 12 months Nonsevere thrombophilia (eg, heterozygous factor V Leiden or prothrombin gene mutation) Recurrent VTE Active cancer (treated within 6 months or palliative) |
Low thrombotic risk | Bileaflet aortic valve prosthesis without atrial fibrillation and no other risk factors for stroke | CHADS2 score 0-2 CHA2DS2-VASc score 0-3 (assuming no prior stroke or transient ischemic attack) | VTE >12 months previous and no other risk factors |
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