Do you use DOAC in patients with mild or moderate rheumatic mitral stenosis?  

Although using DOACs in this population may be safe, these patients were excluded from the large DOAC trials. In addition, MS progresses, so what may be moderate disease today will progress rapidly in some patients. Thus, if anticoagulation is necessary and a VKA is a major issue for the patient, a ...

Anticoagulation is not routinely recommended in patients with mild mitral stenosis who are in sinus rhythm. The risk of thromboembolism in mild mitral stenosis (usually defined as a mitral valve area greater than 1.5 cm²) is much lower than in those with moderate or severe stenosis, particularl...

The question really should be - do you use DOAC in a patient with atrial fibrillation with rheumatic mitral stenosis? Currently, if the stenosis is "moderate or severe," then warfarin is preferred.

DOACs are approved for NVAF. Mild valvular heart disease (mild MS) does not preclude DOAC use. It is usually ‘significant valvular disease’ that precludes DOAC use, in favor of VKA Rx. And ‘significant’ usually means more than moderate MS.