Effect of antithrombotic therapy in patients with mitral stenosis and atrial fibrillation: a sub-analysis of NASPEAF randomized trial

• Published in: European heart journal Vol. 27; no. 8; pp. 960 - 967
• Main Authors: Pérez-Gómez, Francisco, Salvador, Antonio, Zumalde, Javier, Iriarte, Jose A., Berjón, Jesús, Alegría, Eduardo, Almería, Carlos, Bover, Ramón, Herrera, Dionisio, Fernández, Cristina
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-04-2006; Oxford Publishing Limited (England)
• Subjects: Aged; Anticoagulants; Anticoagulants - therapeutic use; Antiplatelets; Atrial fibrillation; Atrial Fibrillation - drug therapy; Biological and medical sciences; Cardiac dysrhythmias; Cardiology. Vascular system; Death, Sudden, Cardiac - etiology; Drug Combinations; Embolism - etiology; Endocardial and cardiac valvular diseases; Female; Fibrinolytic Agents - therapeutic use; Heart; Hemorrhage - etiology; Humans; Male; Medical sciences; Mitral stenosis; Mitral Valve Stenosis - drug therapy; Myocardial Infarction - etiology; Neurology; Platelet Aggregation Inhibitors - therapeutic use; Risk Factors; Severe bleeding; Stroke; Stroke - etiology; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system; Arrhythmia; Cardiovascular disease; Anticoagulant; Mitral stenosis; Hemorrhage; Phlebology; Vascular disease; Randomization; Cardiac valvular disease; Cardiology; Cerebrovascular disease; Severe bleeding; Human; Anticoagulants; Nervous system diseases; Stroke; Atrial fibrillation; Excitability disorder; Antiplatelet agent; Cerebral disorder; Treatment; Analysis; Antiplatelets; Central nervous system disease; Circulatory system; Severe
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehi667

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.