Effect of antithrombotic therapy in patients with mitral stenosis and atrial fibrillation: a sub-analysis of NASPEAF randomized trial.
OBJECTIVE
The randomized NASPEAF study included non-valvular with prior embolism and mitral stenosis patients in the same group. This is a sub-study to specially focus on the antithrombotic therapy in mitral stenosis.


RESULTS
We analysed 311 patients with mitral stenosis, compared with 175 non-valvular atrial fibrillation patients with prior embolism, stratified by a history of previous embolism and assigned to anticoagulant therapy [target international normalized ratio (INR) = 2.0-3.0] or combined antiplatelet plus moderate intensity anticoagulant therapy. Median follow-up was 2.9 years. Outcomes were fatal and non-fatal embolism, stroke and myocardial infarction, sudden death, and death from bleeding. Combined therapy in mitral stenosis patients, compared with anticoagulant alone therapy, reduced the risk of vascular events by 58.3%. During equal therapy, the outcome annual rates were essentially the same in non-valvular and valvular patients [hazard ratio 0.90 (95% confidence interval 0.37-2.16), P = 0.81]. During anticoagulant alone therapy, the annual event rate in mitral stenosis patients without prior embolism was low (2.5%) and it was very high in patients with prior embolism (6.6%).


CONCLUSIONS
Combined therapy was effective in mitral stenosis patients. Prior embolism patients are not efficiently protected with anticoagulant alone therapy for an INR of 2.0-3.0.
Pérez-Gómez
Francisco
F
Servicio de Cardiología, Hospital Clinico San Carlos, Prof. Martín Lagos s/n., 28040 Madrid, Spain. fperezg.hcsc@salud.madrid.org
Salvador
Antonio
A
Zumalde
Javier
J
Iriarte
Jose A
JA
Berjón
Jesús
J
Alegría
Eduardo
E
Almería
Carlos
C
Bover
Ramón
R
Herrera
Dionisio
D
Fernández
Cristina
C
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D016757:Death, Sudden, Cardiac / Q000209:etiology; D004338:Drug Combinations; D004617:Embolism / Q000209:etiology; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008946:Mitral Valve Stenosis / Q000188:drug therapy*; D009203:Myocardial Infarction / Q000209:etiology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome
D000925:Anticoagulants; D004338:Drug Combinations; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors