The letters by Drs Romanic, Alves, and Lebow and Ross raise important questions about the management of mitral valve prolapse and are greatly appreciated.In response to Dr Romanic's comments, I do not believe that the in vitro studies reported by Walsh et al would justify subjecting 5% of the population to antiplatelet therapy, which has its own risks. As I pointed out in my article, because of the high prevalence of mitral valve prolapse and the rare occurrence of cerebral ischemic episodes, antiplatelet therapy is not advocated on a preventive basis in all patients with mitral valve prolapse.1,2Dr Alves would favor antiplatelet therapy in women who have mitral valve prolapse and are using oral contraceptive agents and would advocate screening women using oral contraceptives for mitral valve prolapse. To the best of my knowledge, the hypercoagulability caused by oral contraceptives is due to a defect
Jeresaty RM. The Management of Mitral Valve Prolapse-Reply. JAMA. 1986;255(7):904–905. doi:10.1001/jama.1986.03370070058019
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