title: Oral anticoagulation for stroke prevention amongst atrial fibrillation patients with valvular heart disease: an update.
abstract: OBJECTIVE
  The majority of evidence on the safety and efficacy of oral anticoagulation for stroke prevention amongst patients with atrial fibrillation is derived from those without significant valvular heart disease. This article will review current knowledge, areas of uncertainty and controversy, and ongoing research on oral anticoagulation for stroke prevention amongst patients with valvular heart disease.
  
  
  RESULTS
  The rates of stroke, systemic embolism, and major bleeding were similar for patients with and without significant native valvular disease when treated with direct oral anticoagulants (DOACs) or vitamin K antagonists. There are very limited prospective data on the safety and efficacy of DOAC use for patients with bioprosthetic valves or rheumatic mitral stenosis.
  
  
  CONCLUSIONS
  Atrial fibrillation patients with concomitant valvulopathies constitute a group with high thromboembolic risk and should be treated with oral anticoagulation. There is good supportive evidence that DOAC is well tolerated and effective in preventing thromboembolism amongst patients with native valvular disease. Further research is underway to better define the risks and benefits of DOAC use among patients with bioprosthetic valves or rheumatic mitral stenosis in preventing thromboembolic events. Until then, vitamin K antagonists remain the oral anticoagulant of choice for these patient subsets.
authors.affiliation: aPeter Munk Cardiac Centre, University Health Network bDepartment of Medicine, University of Toronto, Toronto cDivision of Cardiology, Southlake Regional Health Centre, Newmarket dLi Ka Shing Knowledge Institute, St Michael's Hospital eDepartment of Surgery, University of Toronto fDivision of Cardiac Surgery, St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Andrew C T
authors.initials: AC
authors.lastname: Ha
authors.forename: Atul
authors.initials: A
authors.lastname: Verma
authors.forename: Subodh
authors.initials: S
authors.lastname: Verma
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D006349:Heart Valve Diseases; D006801:Humans; D020521:Stroke / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants