Concomitant Valvular Heart Disease
European Society of Cardiology (ESC): 2020 ESC Guidelines for the Diagnosis and Management of Atrial Fibrillation Developed in Collaboration with the European Association of Cardio-Thoracic Surgery (EACTS): The Task Force for the Diagnosis and Management of Atrial Fibrillation of the European Society of Cardiology (ESC) Developed with the Special Contribution of the European Heart Rhythm Association (EHRA) of the ESC (Hindricks et al, Eur Heart J 2020 and SUPPL)
The ESC, in collaboration with the EACTS and developed with the EHRA, updated its 2016 guidelines for the screening, diagnosis, assessment, and management of atrial fibrillation (AF) in patients with or without comorbid cardiovascular disease (CVD), including valvular heart disease (direct oral anticoagulants [DOACs] are not indicated for use in patients with mechanical heart valves). Options for rate and rhythm control are described. Strategies for minimizing bleeding risk and managing bleeding episodes (including reversal options) are included, as are recommendations for periprocedural management of anticoagulation, including in patients undergoing ablation or cardioversion. Risks and benefits of DOACs and vitamin K antagonists (VKAs) are highlighted. Sample pathways to help guide decision-making are included for various clinical scenarios. These guidelines also include quality and performance indicators that may be used to evaluate the level of implementation of the guidelines and identify opportunities for improvement.
Non-Vitamin K Antagonist Oral Anticoagulants in Atrial Fibrillation Patients With Bioprosthetic Valves (Andrade et al, Expert Rev Cardiovasc Ther 2018)
Direct oral anticoagulants (DOACs) are not indicated for use in patients with AF and mechanical heart valves because the safety and efficacy of DOACs have not been studied in patients with prosthetic heart valves. This article reviews the limited data on the efficacy and safety of DOACs for reduction of stroke risk in patients with AF and bioprosthetic heart valves.
Direct Oral Anticoagulant Use in Nonvalvular Atrial Fibrillation With Valvular Heart Disease: A Systematic Review (Owens et al, Clin Cardiol 2017)
This systematic review describes the limited data available on the safety and efficacy of DOACs in patients with NVAF and comorbid valvular heart disease (VHD). DOACs are not indicated for use in patients with mechanical heart valves.