ABSTRACT
The incidence of thromboembolic complications in cases of mitral stenosis [MS] associated with atrial fibrillation [AF] is around 20%. To prevent this complication, warfarin and aspirin is administered to keep the INR between 2 and 3. However, this treatment is associated with increased risk of hemorrhagic episodes. Fifty-five patients with both rheumatic MS and AF, were randomly divided into two groups; Twenty-five patients received 2.5-mg of warfarin and 100 mg of aspirin daily, and thirty patients served as control. The mean +/- SD INR in the treatment group [1.58 +/- 0.45] was significantly higher than that of the control group [1.175 +/- 0.21] [p < 0.001]. Twenty per cent of the control group developed thromboembolic complications. However, none of the patients in the treatment group had any thromboembolic or hemorrhagic events. No inter - or intra-patient INR variability was seen. Therefore the use of low-dose warfarin - aspirin combination for the prevention of thromboembolic complications in patients with MS associated with AF is effective and safe, and thus, is strongly suggested