“A Tale of Two Cities”: Anticoagulation Management in Patients with Atrial Fibrillation and Prosthetic Valves in the Era of Direct Oral Anticoagulants

Giuseppe Palmiero; Enrico Melillo; A Rubino

doi:10.3390/medicina55080437

August 4, 2019MedicinaOpen Access

“A Tale of Two Cities”: Anticoagulation Management in Patients with Atrial Fibrillation and Prosthetic Valves in the Era of Direct Oral Anticoagulants

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Why the study?

While DOACs are the main therapeutic option in non-valvular atrial fibrillation, new evidence is emerging regarding their role in patients with valvular atrial fibrillation, including mechanical and biological prosthetic valves.

Structured PICO

P

Population

Patients with valvular heart disease and atrial fibrillation (mechanical and biological prosthetic valves)

I

Intervention

Direct oral anticoagulants (DOACs)

C

Comparator

Vitamin K antagonists

Implication

This review explores the emerging evidence for the use of direct oral anticoagulants in patients with atrial fibrillation and prosthetic heart valves.

Abstract

Valvular heart disease and atrial fibrillation often coexist. Oral vitamin K antagonists have represented the main anticoagulation management for antithrombotic prevention in this setting for decades. Novel direct oral anticoagulants (DOACs) are a new class of drugs and currently, due to their well-established efficacy and security, they represent the main therapeutic option in non-valvular atrial fibrillation. Some new evidences are exploring the role of DOACs in patients with valvular atrial fibrillation (mechanical and biological prosthetic valves). In this review we explore the data available in the medical literature to establish the actual role of DOACs in patients with valvular heart disease and atrial fibrillation.