The incidence of thromboembolism is higher with mitral than with aortic mechanical valves, and it is lower in mitral mechanical valve patients with a higher rather than a lower INR. In the GELIA (German Experience with Low Intensity Anticoagulation) study of patients with a mechanical mitral prosthesis, a lower INR range (2.0 3.5) was associated with a lower survival rate than that seen with a higher target INR Patient compliance may be challenging with higher INR goals. In one study, patients with a target INR between 2.0 and 3.5 were within that range 74.5% of the time. In contrast, patients with a target INR of 3.0 to 4.5 were within range only 44.5% of the time. An INR target of 3.0 (range, 2.5 3.5) provides a rea- sonable balance between the risks of under- or over-anticoagulation in patients with a mechani- cal mitral valve.9 5. Prior recommendations about the use of anti- platelet therapy after TAVI were derived from the protocols used in the pivotal randomized stud- ies showing the safety and effectiveness of this technology. These protocols were in turn adopted from studies of patients undergoing PCI. The small and underpowered ARTE trial (Aspirin Versus Aspirin plus Clopidogrel Following Transcatheter Aortic Valve Implantation) suggested that single- agent therapy, compared with dual-agent ther- apy, tended to reduce the risk of major adverse events (death, myocardial infarction, stroke, tran- sient ischemic attack, and major or life-threaten- ing bleeding) after TAVI. 