One nonrandomized study found that warfarin reduced the risk of recurrent stroke in patients with mobile thoracic atheroma detected by transesophageal echo- In another nonrandomized study, patients with aortic plaques >4 mm thick treated with oral anticoagulants had fewer stroke and peripheral embolic events than those treated with antiplatelet therapy.510 A retrospective analysis of patients with severe thoracic aortic plaque found that statin therapy (OR, 1.2) or antiplatelet therapy (OR, 1.4; 95% CI, 0.8 2.4), reduced the risk of stroke, TIA, and peripheral emboli.511 Other Cardiac Conditions: Summary and Gaps Cardiac conditions, including MI, cardiomyopathy, valvular heart disease, PFO and ASAs, cardiac tumors, and aortic ath- erosclerosis, are associated with an increased risk for stroke. Therapies to prevent stroke in many of these conditions are based on well-reasoned consensus of opinion, but random- ized, prospective trials to support these decisions are often lacking. For example, therapy with a vitamin K antagonist is reasonable for patients with STEMI and left ventricular mural thrombi, but clinical trials could inform the duration of treatment. Prospective trials are lacking to determine whether antithrombotic therapy is useful for the primary prevention of stroke in patients with mitral valve prolapse and mitral regurgitation who do not have AF. Comparative-effectiveness trials would be useful to determine which antithrombotic would be most effective in reducing the risk of stroke in patients with large aortic plaques. Other Cardiac Conditions: Recommendations 1. Anticoagulation is indicated in patients with mitral stenosis and a prior embolic event, even in sinus rhythm (Class I; Level of Evidence B). 2. Anticoagulation is indicated in patients with mitral stenosis and left atrial thrombus (Class I; Level of Evidence B). 3. 