International Normalized Ratio (INR) Targets: Valvular Disease 

Updated: Dec 10, 2014
  • Author: Buck Christensen; Chief Editor: Buck Christensen  more...
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International Normalized Ratio (INR) Targets: Valvular Disease

The international normalized ratio (INR) recommendations below are per guidelines from the American College of Chest Physicians (2008). [1]

Rheumatic mitral valve disease

See the list below:

  • INR target (range)
    • Atrial fibrillation (AF), prior embolism, and/or left atrial thrombus: 2.5 (2.0-3.0)
    • AF plus systemic embolism or left atrial thrombus: 3.0 (2.5-3.5)
    • Normal sinus rhythm plus left atrial diameter >55 mm: 2.5 (2.0-3.0)
    • Preprocedure percutaneous mitral balloon valvotomy (PMBW) with left atrial thrombus: 3.0 (2.5-3.5)
  • Duration of therapy: Long-term

Mitral valve prolapse

See the list below:

  • INR target (range)
  • Duration of therapy: Long-term

Mitral annular calcification

See the list below:

  • INR target (range)
    • Recurrent systemic embolism, ischemic stroke, or TIA, without AF: 2.5 (2.0-3.0)
    • AF: 2.5 (2.0-3.0)
  • Duration of therapy: long-term

Acute deep venous thrombosis (DVT) of the arm

See the list below:

  • INR target (range): 2.5 (2.0-3.0)
  • duration of therapy: ≥3 months

Calcific aortic valve disease

See the list below:

  • INR target (range)
    • Ischemic stroke: 2.5 (2.0-3.0)
  • Duration of therapy: Long-term

Patent foramen ovale

See the list below:

  • INR target (range)
    • Cryptogenic ischemic stroke plus risk factors: 2.5 (2.0-3.0)
  • Duration of therapy: Long-term

Mechanical heart valve

See the list below:

  • INR target (range)
    • Bileaflet mechanical valve in aortic position, sinus rhythm, no left atrial enlargement: 2.5 (2.0-3.0)
    • Tilting-disk or bileaflet mechanical valve in mitral position: 3.0 (2.5-3.5)
    • Caged-ball or caged-disk: 3.0 (2.5-3.5)
    • Risk factors: 3.0 (2.5-3.5)
    • Systemic embolism despite therapeutic INR: Increase from 2.5 to 3.0 (2.5-3.5) or 3.0 to 3.5 (3.0-4.0)
    • Aortic position with prosthetic valve thrombus: 3.5 (3.0-4.0)
    • Mitral position with prosthetic valve thrombus: 4.0 (3.5-4.5)
  • Duration of therapy: Long-term

Bioprosthetic heart valve

See the list below:

  • INR target (range)
    • Mitral position: 2.5 (2.0-3.0)
    • History of systemic embolism: 2.5 (2.0-3.0)
    • Left atrial thrombus: 2.5 (2.0-3.0)
    • Risk factors: 2.5 (2.0-3.0)
  • Duration of therapy
    • Mitral position: 3 months
    • History of systemic embolism: ≥3 months
    • Left atrial thrombus: Until documented resolution
    • Risk factors: Long-term
  • Risk factors: AF, anterior-apical ST-segment elevation myocardial infarction, left atrial enlargement, hypercoagulable state, low ejection fraction