In patients with ischemic stroke or TIA and IE who present with recurrent emboli and persistent vegetations despite appropri- ate antibiotic therapy, early surgery (during initial hospitalization before completion of a full therapeutic course of antibiotics) is reasonable to reduce the risk of recurrent embolism if there is no evidence of intracra- nial hemorrhage or extensive neurological In patients with history of ischemic stroke or TIA and a mechanical aortic valve, anti- coagulation with higher-intensity warfarin to achieve an INR of 3.0 (range, 2.5 3.5) or the addition of aspirin (75 100 mg/d) can be beneficial to reduce the risk of thromboem- bolic events. In patients with ischemic stroke or TIA and native left-sided valve endocarditis who exhibit mobile vegetations >10 mm in length, early surgery (during initial hospitalization before completion of a full therapeutic course of anti- biotics) may be considered to reduce the risk of recurrent embolism if there is no evidence of intracranial hemorrhage or extensive neurologi- In patients with ischemic stroke or TIA and IE, early valve surgery (during initial hospital- ization before completion of a full therapeutic course of antibiotics) may be considered in patients with an indication for surgery who have no evidence of intracranial hemorrhage or extensive neurological damage.466,467 In patients with IE and major ischemic stroke, delaying valve surgery for at least 4 weeks may be considered for patients with IE and major ischemic stroke or intracranial hemorrhage if the patient is hemodynamically 3: Harm B-R In patients with ischemic stroke or TIA and mechanical heart valves, treatment with dabigatran causes harm.*457 *A similar recommendation in another guideline is worded slightly differently; however, the process used to reach consensus was the same in both cases. 