For patients with AF, including those with paroxysmal AF, for recommendations in favor of oral anticoagulation (including 2.1.9, gest dabigatran 150 mg twice daily rather than adjusted-dose VKA therapy (target INR range, 2.0-3.0) (Grade 2B). Remarks: Dabigatran is excreted primarily by the kidney. It has not been studied and is contraindi- cated in patients with severe renal impairment (estimated creatinine clearance of 30 mL/min). Clinicians should be aware that there is no antidote for dabigatran. 2.1.12 Tailoring These Recommendations to Indi- vidual Patients: As with all weak recommendations, treatment decisions should be individualized based on patient values and preferences, and in this case, an assessment of bleeding risk, and a consideration of additional risk factors for stroke. Bleeding Risk Assessment We have not made separate recommendations depending on patient www.chestpubs.org CHEST / 141 / 2 / FEBRUARY, 2012 SUPPLEMENT e559S no formal recommendations regarding LAA clo- sure devices, pending more de nitive research in this eld. 2.2 Patients With AF and Mitral Stenosis Patients with AF in the setting of rheumatic mitral valve disease, particularly mitral stenosis, are at high risk of stroke. Most RCTs of adjusted-dose VKA therapy in AF excluded such patients. We believe that the results of randomized clinical trials in patients with nonrheumatic AF can be generalized to patients with mitral stenosis. Recommendation 2.2. For patients with AF and mitral stenosis, we recommend adjusted-dose VKA therapy (target INR range, 2.0-3.0) rather than no therapy, aspirin (75 mg to 325 mg once daily), or combi- nation therapy with aspirin and clopidogrel (all Grade 1B). 