Mitral Stenosis — RACP Adult Medicine MCQ
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Correct answer: A — Use a vitamin K antagonist with an individually monitored therapeutic INR target
The best answer is “Use a vitamin K antagonist with an individually monitored therapeutic INR target”. Rheumatic mitral stenosis with AF and atrial thrombus carries very high embolic risk and is treated with a vitamin K antagonist; direct oral anticoagulants are not the preferred substitute in this setting. Antiplatelet therapy is less effective, and anticoagulation is required independently of a cardioversion plan. Valve intervention and rate or rhythm management are assessed separately.
Reference: Heart Foundation: Heart valve disease: https://www.heartfoundation.org.au/your-heart/heart-valve-disease Medical Journal of Australia: Australasian venous thromboembolism guideline: https://www.mja.com.au/journal/2019/new-guidelines-venous-thromboembolism