Advances in Neurocardiology: Focus on Anticoagulation for Valvular Heart Disease With and Without Atrial Fibrillation

Stroke prevention; atrial fibrillation; heart and brain; anticoagulation; direct oral anticoagulantsThe prevalence of valvular heart disease (VHD) is increasing steadily globally because of the aging population. 1 Most physicians managing stroke patients are familiar with stroke prevention in atrial fibrillation (AF), patent foramen ovale, and other cardioembolic diseases.However, they are less familiar with the management of antithrombotic agents in different types of VHD.Nine Phase II and Phase III randomized clinical trials (RCTs) of direct oral anticoagulants (DOACs) in different types of VHD have been published since 2020 (Figure 1).[2][3][4][5][6][7][8][9][10] This article updates current evidence from RCTs on the use of DOACs in patients with mechanical valve replacement, moderate/severe mitral stenosis, bioprosthetic valves, and transcatheter aortic valve replacement (TAVR) from the perspective of stroke physicians.Although stroke endpoints were reported in most RCTs included in this update, none of the studies focused exclusively on patients with a prior cerebrovascular event.Therefore, our analysis of current evidence is based on populations with and without a prior stroke or TIA.Ongoing RCTs are discussed in the online supplemental material.