Low-Intensity Anticoagulation Effective And Safe In Mitral Stenosis And Atrial Fibrillation

Low-intensity anticoagulation is an “effective and safe” strategy to prevent thromboembolism in patients with mitral stenosis and atrial fibrillation.

This open randomised prospective study, undertaken by researchers from the University of Padova, Italy, enrolled 103 patients with mitral stenosis and atrial fibrillation. They received either low or moderate anticoagulation, defined as international normalised ratios (INR) for prothrombin time of 2 and 3 respectively. Patients were followed for a mean of 4.5 years.

During follow-up, one patient receiving low-intensity anticoagulation experienced systemic embolism, equivalent to an incidence of 0.41 per 100 patient years. One patient in the moderate intensity group experienced a minor stroke, an incidence of 0.40 per 100 patient years.

Three patients in the low intensity group and five patients receiving moderate intensity anticoagulation experienced major bleeds, equivalent to incidences of 1.25 and 2.0 per 100 patient years respectively. Overall, seven and eight patients in the low and moderate intensity groups respectively experienced systemic embolism, major bleeding and vascular death.

As the authors expected, minor bleeding was more frequent among patients that received moderate intensity anticoagulation. These patients received more intense treatment and required closer monitoring than those receiving low intensity anticoagulation.

Thrombosis and Haemostasis 2003;89:760-764