Antithrombotic Therapy After Mechanical Mitral Valve Prosthesis

A 58-year-old man with a history of severe, symptomatic, chronic mitral regurgitation without left ventricular dysfunction presents to your clinic after recently moving for a new job. He underwent mitral valve replacement with mechanical valve prosthesis five years ago, and has been asymptomatic ever since. He takes warfarin 5 mg and aspirin 81 mg daily but wonders if he can transition to a different drug without regular monitoring. Additionally, he reports concern over taking both aspirin and warfarin because a close friend was recently hospitalized for a gastrointenstinal bleed, and requests discontinuation of his aspirin.

Which of the following is the most appropriate antithrombotic strategy for this patient?

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