The findings suggested that patients on VKA therapy who have an INR between 4.5 and 10.0 and are not bleeding are not likely to benefit from routine vitamin K administration in addition to temporary VKA cessation.13 11.5. Thromboembolic Events With Prosthetic Valves Recommendations for Management of Thromboembolic Events With Prosthetic Valves COR LOE Recommendations In patients with a mechanical AVR who experience a stroke or systemic embolic event while in therapeutic range on VKA anticoagulation, it is reasonable to increase the INR goal from 2.5 (range, 2.0 3.0) to 3.0 (range, 2.5 3.5) or to add daily low-dose aspirin (75 100 mg), with assessment of bleeding risk. In patients with a mechanical mitral valve replacement who experience a stroke or systemic embolic event while in therapeutic range on VKA anticoagulation, it is reasonable to increase the INR goal from 3.0 (range, 2.5 3.5) to 4.0 (range, 3.5 4.0) or to add daily low-dose aspirin (75 100 mg), with assessment of bleeding risk. In patients with a bioprosthetic surgical or transcatheter aortic valve or bioprosthetic mitral valve who experience a stroke or systemic embolic event while on antiplatelet therapy, VKA anticoagulation, instead of antiplatelet therapy may be considered after assessment of bleeding risk.1,2 Synopsis For patients with a mechanical valve who suffer an embolic event, it is important to assess the adequacy CLINICAL STATEMENTS AND GUIDELINES of VKA anticoagulation, document time spent in the therapeutic range, exclude IE, screen for new-onset AF, and consider whether an underlying hypercoagulable state might be a contributing factor. Thromboembolism in bioprosthetic heart valve recipients should similarly raise suspicion of IE or new-onset AF in the right clini- cal setting. 