In the recent years, there has been significant transformation in the management of valvular heart disease (VHD), as a result of new minimally invasive technologies, such as the transcatheter aortic valve implantation (TAVI). Conventionally, mechanical heart valves require anticoagulation with warfarin to prevent thrombogenic events. Lately, there has been an uptrend in the usage of direct-acting oral anticoagulants (DOACs) in both mechanical and bioprosthetic heart valves. In clinical practice, there has shown to be notable heterogeneity in the antithrombotic regimen for patients. Recommendations from clinical guidelines and emerging data on DOAC use in these settings will be critically reviewed here. Future large, randomized-controlled trials are warranted to delineate the role of DOACs in patients receiving a bioprosthetic valve/TAVI or mechanical heart valve, with and without a baseline indication for anticoagulation or antiplatelets. Until clinical trial data from well-designed studies are available, providers must remain vigilant about DOAC use in patients with VHD, especially in patients with a bioprosthetic or mechanical heart valve.

中文翻译：

---

机械和生物人工心脏瓣膜中的 DOAC：新兴数据和未来方向的叙述性回顾。

近年来，由于新的微创技术，如经导管主动脉瓣植入术 (TAVI)，瓣膜性心脏病 (VHD) 的管理发生了重大转变。通常，机械心脏瓣膜需要用华法林抗凝以防止血栓形成事件。最近，直接作用口服抗凝剂 (DOAC) 在机械和生物假体心脏瓣膜中的使用呈上升趋势。在临床实践中，患者的抗血栓治疗方案存在显着的异质性。此处将严格审查来自临床指南的建议和有关在这些环境中使用 DOAC 的新数据。未来大，有必要进行随机对照试验来描述 DOAC 在接受生物瓣膜/TAVI 或机械心脏瓣膜的患者中的作用，无论是否有抗凝或抗血小板的基线指征。在获得精心设计的研究的临床试验数据之前，提供者必须对 DOAC 在 VHD 患者中的使用保持警惕，尤其是在具有生物假体或机械心脏瓣膜的患者中。