Valvular Heart Disease And “Nonvalvular Atrial Fibrillation” Coumadin or a Novel Oral Anticoagulant Variables to Consider

Abstract

Clinicians treating atrial fibrillation must initially identify and ultimately verify whether this rhythm fits within the definition of “non-valvular” atrial fibrillation (NVAF). The spectrum of structural heart disease can render this process a challenge as what is meant by NVAF is continually evolving. Phenotypic variants in valvular heart disease including repaired valvular injury have undergone definitional updates pertaining to NVAF. This has produced inconsistencies in each subsequent authoritative guideline often further confusing practitioners. At issue is whether a vitamin K dependent antagonist (VKA) exemplified by warfarin, or one of the new novel oral anticoagulants (NOACs) is appropriate to treat NVAF in a patient with a form of valvular heart disease. The present effort is a practical review of the current clinical landscape wherein practitioners struggle to advise and treat patients with optimal anticoagulation therapy with NVAF as currently defined. It is also a review of why certain valvular conditions may actually still fit within the definition of NVAF allowing NOAC use.