In the Guideline Watch, Update to the Atrial Fibrillation Guideline: A Focus on Anticoagulation Strategies, we have modified the language to clarify treatment of patients with valvular heart disease, who should avoid use of direct-acting oral anticoagulants. The third and fourth bullet points now read:
Direct-acting oral anticoagulants (DOACs) are preferred over warfarin, except in certain cases such as valvular heart disease.
Valvular heart disease is now defined more narrowly as moderate-to-severe mitral stenosis or a mechanical heart valve. For patients with AF who have mechanical heart valves or moderate-to-severe mitral stenosis, warfarin, not DOACs, is recommended.