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Optimal Oral Anticoagulant Therapy in Patients with Mechanical Heart Valves NEJM 333:11-17, 541995., Cannegieter,S.C.,et al, 1995 See this aricle in Pubmed Article Abstract A total of 1608 patients were followed during 6475 patient-years.Cerebral embolism occurred in 43 patients(0.68 per 100 patient-years)and peripheral embolism in 2(0.3 per 100 patient-years).Intracranial and spinal bleeding occurred in 36 patients(0.57 per 100 patient-years)and major extracranial bleeding in 128(2.1 per 100 patient-years).The optimal intensity of anticoagulation,at which the incidence of both complications was lowest, was achieved when the INR was between 2.5 and 4.9.The intensity of anticoagulant therapy for patients with prosthetic heart valves is optimal when the INR is between 2.5 and 4.9.To achieve this level of anticoagulation,a target INR of 3.0 to 4.0 is recommended.

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