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The early randomized controlled trials comparing direct-acting oral anticoagulants (DOACs) and warfarin for atrial fibrillation (AF) excluded patients with valvular disease. However, later trials included more patients with valvular AF, and the most recent study excluded only those patients with mechanical valves and moderate-to-severe mitral stenosis. Now, researchers have examined a large commercial database to compare DOACs and warfarin in 56,336 patients with valvular AF matched on propensity score and outcomes.
Patients with valve replacement, whether mechanical or bioprosthetic, were excluded. Median follow-up was short: 134 days for DOAC users and 124 days for warfarin users. DOACs were associated with lower risks, compared with warfa…