What is the target therapeutic International Normalized Ratio (INR) for a patient receiving warfarin for a mechanical bileaflet aortic valve prosthesis without other thromboembolic risk factors?

Answer and explanation

Correct answer: D. 2.0 to 3.0

  1. Step 1: According to international cardiology guidelines, the target INR for a mechanical bileaflet aortic valve in the absence of additional risk factors (such as atrial fibrillation, previous thromboembolism, or LV dysfunction) is 2.5 (target range 2.0 to 3.0).
  2. Step 2: A higher target range (2.5 to 3.5) is required for mechanical mitral valves or aortic valves with associated thromboembolic risk factors.
Answer
2.0 to 3.0.
Why not the others: '1.5 to 2.0' is subtherapeutic and risks valve thrombosis; '2.5 to 3.5' is the target for mechanical mitral valve prostheses; '3.0 to 4.0' excessively increases major bleeding risk without added protective benefit.

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