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©2013 UpToDate ® Print Email ACC/AHA guideline summary: Antithrombotic therapy in symptomatic patients with mitral valve prolapse (MVP) Class I - There is evidence and/or general agreement that antithrombotic therapy with aspirin or warfarin is indicated in patients with MVP in the following settings • Aspirin (75 to 325 mg/day) for: 1. Cerebral transient ischemic attacks. 2. In patients under age 65 for atrial fibrillation in the absence of mitral regurgitation, hypertension, or heart failure, all of which are risk factors for thromboembolism. • Warfarin for: 1. Atrial fibrillation in patients ≥65 years of age or those with a murmur of mitral regurgitation, hypertension, or a history of heart failure. 2. In patients with a history of stroke who have mitral regurgitation, atrial fibrillation, or left atrial thrombus. Class IIa - The weight of evidence or opinion is in favor of the usefulness of aspirin or warfarin in patients with MVP in the following settings • Aspirin (75 to 325 mg/day) for: 1. A history of stroke in the absence of mitral regurgitation, atrial fibrillation, left atrial thrombus, or, on echocardiography, thickening (≥5 mm) or redundancy of the mitral valve leaflets. 2. A history of stroke if there are contraindications to warfarin therapy. • Warfarin for: 1. A history of stroke in the absence of mitral regurgitation, atrial fibrillation, or left atrial thrombus if echocardiography shows thickening (≥5 mm) and/or redundancy of the mitral valve leaflets. 2. Cerebral transient ischemic attacks despite aspirin therapy. Class IIb - The weight of evidence or opinion is less well established for the usefulness of aspirin in patients with MS in the following setting • Aspirin (75 to 325 mg/day) in patients in sinus rhythm who have high risk findings of mitral valve prolapse on echocardiography. Data from: Bonow RO, Carabello BA, Chatterjee K, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing committee to revise the 1998 guidelines for the management of patients with valvular heart disease). J Am Coll Cardiol 2006; 48:e1.