Direct Oral Anticoagulants Are Now Available for Patients With Atrial Fibrillation and Bioprosthetic Heart Valves

ness and safety of DOACs in patients with "valvular including those mechanical heart or moderate to severe mitral has never been proven. n the Dabigatran Versus Warfarin After Bioprosthesis Valve Replacement for the Management of Atrial Fibrillation Postoperatively (DAWA) pilot study, 5 the effect of dabigatran was similar to that of in preventing the formation of intracardiac thrombi. Among the 191 patients A trial fibrillation (AF) is conventionally divided into "valvular" and "non-valvular". In the 2012 focused update of the European Society of Cardiology (ESC) guidelines for the management of AF, 1 the term "valvular AF" was used to denote AF related to rheumatic valvular diseases (predominantly mitral stenosis) or prosthetic heart valves. However, in relation to artificial valves, it was not clearly mentioned whether bioprosthetic valves should be categorized as "valvular" or "non-valvular". 1 The 2020 ESC guidelines recommended that this terminology should be abandoned. 2 Nevertheless, these definitions are clinically important for physicians to select an appropriate oral anticoagulant in patients with AF and bioprosthetic valves because direct oral anticoagulants (DOACs) are currently only approved for patients with non-valvular AF.