Postoperative management

Postoperative management

Antibiotic prophylaxis Currently the National Institute for Health and Care Excellence recommends that prophylactic antibiotics are not required for patients with prosthetic valves undergoing dental procedures. Other leading European bodies have recently supported the above recommendation. Antithrombotic therapy All patients with mechanical valves require anticoagulation, usually started on the first or second postoperative day . Use of anticoagulants with biological valves is based largely on the manufacturer’s guidance. Direct oral anticoagulants such as apixaban and rivarox - aban are not currently licensed for use with mechanical pros - thetic valves. Warfarin is currently the drug of choice and the target international normalised ratio (INR) should be adapted to patient risk factors and thrombogenicity of the prosthesis with evidence supporting a lower INR target for aortic valves; however, the range of INR can vary between 2.5 and 4.