Feasibility of aspirin in primary prevention of stroke in rheumatic heart disease and sinus rhythm

Abstract

Background: Thromboembolism is frequently seen in patients of rheumatic mitral stenosis with atrial 
fibrillation. It is however, not uncommon in those with sinus rhythm. Since anticoagulants are not routinely 
recommended in rheumatic mitral stenosis patients with sinus rhythm, antiplatelet therapy may be considered 
as a preventive means.
Methods: Patients with rheumatic mitral stenosis [mitral valve area < 2cm2
], in sinus rhythm and at least1 
additional risk factor for embolism (severe MS, left atrial size greater than 50 mm, spontaneous echo contrast 
and significant aortic regurgitation) were enrolled. Exclusion criteria included a history of stroke/ transient 
ischemic attack, systemic embolism or oral anticoagulation. Daily dose of 75 mg of enteric coated aspirin was 
prescribed. Follow- up was done at every 3 months telephonically and 6 months in the out-patient clinic. The 
primary outcome was composite of major and non-major bleeding. The secondary outcome was composite of 
stroke/ transient ischemic attack, or systemic embolism.