Antithrombotic And Thrombolytic Therapy For Valvular Disease

In patients with rheumatic mitral valve disease and normal sinus rhythm with a left atrial diameter <55 mm, we suggest not using antiplatelet or VKA therapy. (2, C)

In patients with rheumatic mitral valve disease and normal sinus rhythm with a left atrial diameter >55 mm, we suggest VKA therapy (target INR, 2.5; range, 2.0-3.0) over no VKA therapy or antiplatelet. (2, C)

For patients with rheumatic mitral valve disease complicated singly or in combination by the presence of AF or previous systemic embolism, we recommend VKA therapy (target INR, 2.5; range, 2.0-3.0) over no VKA therapy. (1, A)

For patients with rheumatic mitral valve disease complicated singly or in combination by the presence of left atrial thrombus, we recommend VKA therapy (target INR, 2.5; range, 2.0-3.0) over no VKA therapy. (1, A)

For patients being considered for percutaneous mitral balloon valvuloplasty (PMBV) with preprocedural TEE showing left atrial thrombus, we recommend postponement of PMBV and that VKA therapy (target INR, 3.0; range, 2.5-3.5) be administered until thrombus resolution is documented by repeat TEE over no VKA therapy. (1, A)

For patients being considered for PMBV with preprocedural TEE showing left atrial thrombus, if the left atrial thrombus does not resolve with VKA therapy, we recommend that PMBV not be performed. (1, A)