The antithrombotic-thrombolytic effect of low-dose warfarin on the patients with mitral stenosis and left atrial thrombi

This study evaluated the antithrombotic-thrombolytic effect of low-dose warfarin (2 mg qd) in the patients with mitral stenosis and left atrial thrombi. There were 31 patients who are candidates for percutaneous balloon mitral valvuloplasty (PBMV) but with the presence of left atrial thrombi. The diameter of thrombi was 1 cm x 1 cm x 0.5 cm (smallest) to 3 cm x 4 cm x 6 cm (biggest) detected by transesophageal echocardiography (TEE). During follow-up TTE, TEE, PT (prothrombin time) and PTA (prothrombin time activity) were performed periodically. All thrombi disappeared except that three patients were lost during follow-up. The thrombi disappeared after 2-12 months of warfarin therapy. Twenty-four patients (24/28, 86%) had their thrombi disappeared within 6 months. PT was partially prolonged and PTA slightly decreased in all the patients with no hemorrhagic complications. Successful PBMV was performed in all the patients after resolution of left atrial thrombi. The results suggested that the antithrombotic-thrombolytic effect of low-dose warfarin is safe and reliable for the resolution of left atrial thrombi in the patients with mitral stenosis. Warfarin therapy should be maintained more than 6 months for the majority of patients.