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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 speciall y focus on the antithrombotic therapy in mitral stenosis. Methods and results: W e analysed 311 patients with mitral stenosis, compared with 175 non-valvular at rial fibrillation patients with prior embolism, stratified by a history of previ ous embolism and assigned to anticoagulant therapy [target international normali zed ratio(INR)=2.0-3.0] or combined antiplatelet plus moderate intensity antico agulant therapy. Median follow-up was 2.9 years. Outcomes were fatal and non-f atal embolism, stroke and myocardial infarction, sudden death, and death from bl eeding. Combined therapy in mitral stenosis patients, compared with anticoagulan t alone therapy, reduced the risk of vascular events by 58.3%. During equal the rapy, the outcome annual rates were essentially the same in non-valvular and va lvular 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 pa tients without prior embolism was low(2.5%) and it was very high in patients wi th prior embolism(6.6%). Conclusion: Combined therapy was effective in mitral s tenosis patients. Prior embolism patients are not efficiently protected with ant icoagulant alone therapy for an INR of 2.0-3.0.
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 special focus on the antithrombotic therapy in mitral stenosis. Methods and results: mitral stenosis, compared with 175 non-valvular at rial fibrillation patients with prior embolism, stratified by a history of previ ous embolism and assigned to anticoagulant therapy [target international normali zed ratio (INR) = 2.0-3.0] or combined antiplatelet plus moderate intensity intensity Anticoagulant therapy. Median follow-up was 2.9 years. Outcomes were fatal and non-f atal embolism, stroke and myocardial infarction, sudden death, and death from bl eeding. Combined therapy in mitral stenosis patients, compared with anticoagulan t alone therapy, reduced the risk of vascular events by 58.3%. During equal the rapy, the outcome annual rates were essentially the same in non-valvular and va lular patients [hazard ratio 0.90 (95% c onfidence interval 0.37-2.16), P = 0.81]. During the anticoagulant alone therapy, the annual event rate in mitral stenosis pa tients without prior embolism was low (2.5%) and it was very high in patients wi th prior embolism (6.6%) Conclusion: Combined therapy was effective in mitral s tenosis patients. Prior embolism patients are notfficient protected with anticoagulant alone therapy for an INR of 2.0-3.0.