The Management of Mitral Valve Prolapse

To the Editor.— I found Dr Jeresaty's¹ recent update on mitral valve prolapse in the Aug 9 issue of JAMA very useful. I would like to comment, however, on the use of antiplatelet therapy in these patients.

As was mentioned, mitral valve prolapse probably plays a role in cerebral ischemia, at least in patients younger than 45 years of age.²I would also like to point to a study concerning platelet coagulant hyperactivity in patients with mitral valve prolapse.³ In this study, 100% of patients with mitral valve prolapse and thromboembolic complications showed platelet coagulant hyperactivity, as did 58% of patients with mitral valve prolapse but no history of thromboembolic or visual manifestations. This compared with only 6% of a control group without mitral valve prolapse showing platelet coagulant hyperactivity.

Given this information, antiplatelet prophylaxis appears reasonable, especially in those patients who express concern, verbally or nonverbally, about