Front Panel Painting “LIFE” By William T Chua MD

Risk Factor
Acute MI and LV
thrombus
Cardiomyopathy
MVP
MAC
Aortic valve
disease
Recommendation
For patients with ischemic stroke caused by acute
MI with LV mural thrombus identified by
echocardiography or another form of cardiac
imaging, oral anticoagulation is reasonable
(INR=2.0-3.0 for at least 3 months up to 1 year).
Aspirin up to 160 mg/day (preferably entericcoated)
should be used concurrently for patients
with ischemic CAD during oral anticoagulant
therapy.
For patients with ischemic stroke or TIA who have
dilated cardiomyopathy, either warfarin (INR=2.0-
3.0) or antiplatelet therapy may be considered to
prevent recurrent events.
For patients with MVP who have ischemic stroke or
TIA, long-term antiplatelet therapy is reasonable.
For patients with ischemic stroke or TIA and MAC
not documented to be calcific, antiplatelet therapy
may be considered.
Among patients with MR due to MAC, without AF,
antiplatelet or warfarin therapy may be considered.
For patients with ischemic stroke or TIA and aortic
valve disease who do not have AF, antiplatelet
therapy may be considered.
For patients with ischemic stroke or TIA who have
modern mechanical prosthetic heart valves, oral
anticoagulants are recommended, with an INR
target of 3.0 (range; 2.5-3.5).
Class/Level of
Evidence
Class IIa-B
Class IIa-A
Class IIb-C
Class IIa-C
Class IIb-C
Class IIb-C
Class IIa-C
Class I-B
Primary & Secondary
Prevention
Prosthetic heart
valves
For patients with mechanical prosthetic heart valves
who had an ischemic stroke or systemic embolism
despite adequate therapy with oral anticoagulants,
aspirin 75 to 100 mg/day in addition to oral
anticoagulants maintained at INR of 3.0
(range; 2.5- 3.5) is reasonable.
For patients with ischemic stroke or TIA who have
bioprosthetic heart valves with no other source of
TE, anticoagulation with warfarin (INR=2.0-3.0)
may be considered.
Class IIa-B
Class IIb-C
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