Reply to Standard Versus Higher Intensity Anticoagulation for Patients With Mechanical Aortic Valve Replacement and Additional Risk Factors for Thromboembolism

Abstract

We congratulate Hanigan et al1 on their multicenter observational cohort study comparing standard intensity anticoagulation (international normalized ratio [INR] Goal 2.5; target range 2.0 to 3.0) to higher intensity anticoagulation (INR Goal 3.0; target range 2.5 to 3.5) in patients with a mechanical aortic valve and at least 1 additional thromboembolic risk factor. The findings of this study–-high-intensity warfarin was associated with a higher risk of bleeding without conferring meaningful additional thromboembolic protection––adds to the mounting evidence that contradicts current guidelines, which recommend varying INR targets according to perceived thromboembolic risk after a mechanical aortic valve replacement (INR 2.0 to 3.0 in low risk and INR 2.5 to 3.5 in those with additional risk factors).