The TOAST trial classified various sources relative to the risk of cardioembolism. A high-risk source may require more aggressive management.
Medium-risk sources:
(1) atrial flutter
(2) atrial septal aneurysm
(3) calcification of mitral annulus
(4) congestive heart failure
(5) hypokinetic left ventricular segment
(6) left atrial turbulence
(7) mitral valve prolapse
(8) patent foramen ovale
High-risk sources:
(1) akinetic left ventricular segment
(2) atrial myxoma
(3) dilated cardiomyopathy
(4) left atrial or atrial appendage thrombus
(5) left ventricular thrombus
(6) sick sinus syndrome
|
Source
|
Medium Risk
|
High Risk
|
|
prosthetic valve
|
bioprosthetic
|
mechanical
|
|
mitral stenosis
|
without atrial fibrillation
|
with atrial fibrillation
|
|
atrial fibrillation
|
lone
|
other
|
|
myocardial infarction
|
4 weeks to 6 months
|
less than 4 weeks
|
|
endocarditis
|
nonbacterial thrombotic
|
infective
|
