Abstract
Valvular heart disease and atrial fibrillation often coexist. Oral vitamin K antagonists have represented the main anticoagulation management for antithrombotic prevention in this setting for decades. Novel direct oral anticoagulants (DOACs) are a new class of drugs and currently, due to their well-established efficacy and security, they represent the main therapeutic option in non-valvular atrial fibrillation. Some new evidences are exploring the role of DOACs in patients with valvular atrial fibrillation (mechanical and biological prosthetic valves). In this review we explore the data available in the medical literature to establish the actual role of DOACs in patients with valvular heart disease and atrial fibrillation.
Highlights
Prosthetic valve replacement represents a historical and effective therapeutic approach for symptoms and outcome improvement in patients with valvular heart disease (VHD) [1]
direct oral anticoagulants (DOACs) have several pharmacokinetic advantages compared to vitamin K antagonists (VKAs): A fixed dose, which avoids the necessity for drug monitoring, rapid onset of action and a short-half life, which limits their action during a short time, few interactions with food and drugs, which makes their use easier and safer
Multiple thrombotic risk factors are concomitantly present in the vast majority of patients and for these reasons, long-term anticoagulation is mandatory for Mechanical prosthetic valves (MPV) and the VKAs are the current standard of care in these patients [3,21]
Summary
In 1859 Charles Dickens wrote “A tale of two cities”, a historical novel set in London and Paris during the French Revolution, a transition period from the monarchical ancient regime to a new form of government. As with the introduction into the clinical practice of new therapeutic options for anticoagulation management, a new era is rising, but contrasts are still present. Even in fields of application in which new anticoagulants have proved to be superior to the old molecules (thrombosis prevention in atrial fibrillation and systemic thromboembolism), a sense of comfortability, given by decades of clinical experience of historical anticoagulant drugs, is still contrasting the potential widespread use of new therapeutic option, encouraged by their favorable outcome in terms of efficacy and security. Some new evidence seems able to promote a possible revolution in this setting
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