In patients with a bioprosthetic aortic or mitral valve, a history of ischemic stroke or TIA before valve replacement, and no other indication for anticoagulation therapy beyond 3 to 6 months from the valve placement, long-term therapy with aspirin is recommended in preference to long-term anticoagulation to reduce the risk of recur- rent stroke or TIA. 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. 