Effect of antithrombotic therapy in patients with mitral stenosis and atrial fibrillation: a sub-analysis of NASPEAF randomized trial
Open Access
- 5 December 2005
- journal article
- research article
- Published by Oxford University Press (OUP) in European Heart Journal
- Vol. 27 (8), 960-967
- https://doi.org/10.1093/eurheartj/ehi667
Abstract
Aims 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. Methods and 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%). Conclusion 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.This publication has 17 references indexed in Scilit:
- Comparative effects of antiplatelet, anticoagulant, or combined therapy in patients with valvular and nonvalvular atrial fibrillation: A randomized multicenter studyJournal of Invasive Cardiology, 2004
- Antithrombotic Therapy in Atrial FibrillationSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2004
- Comparison of Triflusal and Aspirin for Prevention of Vascular Events in Patients After Cerebral InfarctionStroke, 2003
- Guidelines for the management of patients with atrial fibrillation. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to develop guidelines for the management of patients with atrial fibrillation) developed in collaboration with the North American Society of Pacing and ElectrophysiologyEuropean Heart Journal, 2001
- Randomized comparative trial of triflusal and aspirin following acute myocardial infarctionEuropean Heart Journal, 2000
- TriflusalDrugs, 1998
- Adjusted-dose warfarin versus low-intensity, fixed-dose warfarin plus aspirin for high-risk patients with atrial fibrillation: Stroke Prevention in Atrial Fibrillation III randomised clinical trialThe Lancet, 1996
- Cerebral embolism and mitral stenosis: survival with and without anticoagulantsJournal of Neurology, Neurosurgery & Psychiatry, 1974
- Mitral valve disease, systemic embolism and anticoagulantsHeart, 1971
- Incidence of systemic embolism before and after mitral valvotomyThorax, 1968