New recommendations Surgical excision is recommended for treatment of atrial myxomas (Class I; Level of Evidence C). New recommendation Table 5. Continued Section 2014 Recommendation Description of Change from 2011 (Continued) Meschia et al Guidelines for the Primary Prevention of Stroke 3803 Other cardiac conditions cont'd Surgical intervention is recommended for symptomatic fibroelastomas and for fibroelastomas that are >1 cm or appear mobile, even if asymptomatic (Class I; Level of Evidence C) New recommendation Aspirin is reasonable after aortic or mitral valve replacement with a bioprosthesis (Class IIa; Level of Evidence C). New recommendation It is reasonable to give warfarin to achieve an INR of 2.0 3.0 during the first 3 mo after aortic or mitral valve replacement with a bioprosthesis (Class IIa; Level of Evidence C). New recommendation Anticoagulants or antiplatelet agents are reasonable for patients with heart failure who do not have atrial fibrillation or a previous thromboembolic event (Class IIa; Level of Evidence A). New recommendation Vitamin K antagonist therapy is reasonable for patients with ST-segment elevation myocardial infarction and asymptomatic left ventricular mural thrombi (Class IIa; Level of Evidence C). The level of evidence has been downgraded from A to C, but the recommendation grade is the same Anticoagulation may be considered for asymptomatic patients with severe mitral stenosis and left atrial dimension 55 mm by echocardiography (Class IIb; Level of Evidence B). New recommendation Anticoagulation may be considered for patients with severe mitral stenosis, an enlarged left atrium, and spontaneous contrast on echocardiography (Class IIb; Level of Evidence C). New recommendation Anticoagulant therapy may be considered for patients with ST-segment elevation myocardial infarction and anterior apical akinesis or dyskinesis (Class IIb; Level of Evidence C). 