Risk of Stroke With Mitral Stenosis: The Underlying Mechanism, Treatment, and Prevention

Abstract

Mitral stenosis (MS), a valvular heart disease, is defined by the narrowing of the mitral valve orifice. The common risk factors for stroke include mitral annular calcification (MAC), diabetes mellitus (DM), male gender, hypertension (HTN), hyperlipidemia, and obesity. Endothelial damage, hypercoagulability, and blood stasis in the left atrium promote the development of the thrombus. Among all the risk factors described, MAC is the independent predictor of stroke. The complicated mechanisms responsible for thromboembolism, predisposing factors for thromboembolism, the risk of cerebrovascular accident (CVA) in MS patients, advanced standardized assessment models for identifying those at risk for stroke, and the possible advantages and disadvantages of available therapies have all been discussed in this review article. We have also discussed newer oral anticoagulants (NOACs) like dabigatran, edoxaban, apixaban, and rivaroxaban. Non-pharmacological therapies are also highlighted such as left atrial appendage ligation and occlusion devices. We also conducted a thorough review of the literature on the efficacy and safety of various NOACs in reducing the risk of stroke.

Lower Limb Deep Venous Thrombosis After Posterior Spinal Fusion as an Initial Manifestation of Factor V Leiden Mutation in a Pediatric Patient: A Case Report

“…Vitamin K antagonists and oral anticoagulation are the most effective long-term treatments for preventing complications such as thromboembolisms [11]. Nonetheless, direct oral anticoagulants are increasingly being used in a variety of conditions and are currently gaining popularity, quickly becoming the mainstay treatment for acute DVT for a role in prolonged treatment due to a decreased risk of bleeding [12].…”

A Difficult Case of Cardio-Cerebral Infarction Syndrome With Left Ventricular Thrombus

“…There is still a lack of consensus on the optimal antithrombotic regimen for MI and LV thrombus with concurrent ischemic stroke. Meta-analyses have shown a controversial result on the use of direct oral anticoagulants (DOACs) compared to vitamin K antagonists for the treatment of LV thrombus [ 5 , 11 , 12 ]. Randomized studies are needed to assess DOAC efficacy, especially in large thrombus burden populations with concurrent ischemic stroke.…”

Analysis of Echocardiographic Findings of Patients with Acute Ischemic Stroke Admitted to a Tertiary Care Hospital in Mogadishu, Somalia

“…31 Even in asymptomatic subjects, LV diastolic dysfunction has been linked to the development of heart failure, future cardiovascular events, and increased mortality, even after controlling for comorbidities. 32,33 In our echocardiography assessment, left ventricular diastolic dysfunction was the most common finding among the assessed variables.…”