It was stopped prematurely for excessive thrombotic and bleeding complications in the dabigatran arm.4,5 The safety and efficacy of conventional-dose oral anti-Xa agents in patients with a mechanical valve prosthesis have not been evaluated.33 36 11.3. Bridging Therapy Recommendations for Bridging Therapy During Interruption of Oral Anticoagulation in Patients With Prosthetic Heart Valves COR LOE Recommendations For patients with mechanical heart valves who are undergoing minor procedures (eg, dental extractions or cataract removal) where bleeding is easily controlled, continuation of VKA anticoagulation with a therapeutic INR is recommended. For patients with a bileaflet mechanical AVR and no other risk factors for thromboembolism who are undergoing invasive procedures, temporary interruption of VKA anticoagulation, without bridging agents while the INR is subtherapeutic, is recommended. For patients with a mechanical valve prosthesis receiving VKA therapy who require immediate/ emergency noncardiac surgery or an invasive procedure, administration of 4-factor prothrombin complex concentrate (or its activated form) is reasonable. Figure 13. Management of embolic events and valve thrombosis. Colors correspond to Table 2. 3D indicates 3-dimensional; 4D, 4-dimensional; AVR, aortic valve replacement; CT, computed tomography; INR, international nor- malized ratio; MVR, mitral valve replacement; Rx, medication; TEE, transesophageal echocardiography; TTE, transthoracic echocardiography; and VKA, vitamin K antagonist. CLINICAL STATEMENTS AND GUIDELINES For patients with bioprosthetic heart valves or annuloplasty rings who are receiving anticoagulation for AF, it is reasonable to consider the need for bridging anticoagulant therapy around the time of invasive procedures on the basis of the CHA2 -VASc score weighed against the risk of bleeding. 