Anticoagulation in Atrial Fibrillation and Rheumatic Heart Disease

The landscape for stroke prevention in atrial fibrillation has been changed by the availability of the direct oral anticoagulants (DOACs) that have been tested in large, prospective, randomized trials for stroke prevention in patients with so-called nonvalvular atrial fibrillation. However, the definition of what is valvular or nonvalvular atrial fibrillation has been subject to much debate. The general consensus is that patients with atrial fibrillation and clinically significant valvular heart disease (defined as the use of prosthetic mechanical heart valves or moderate-to-severe mitral stenosis) should be treated with vitamin K antagonists (e.g., warfarin), whereas all other patients with atrial fibrillation . . .