*457 *A similar recommendation in another guideline is worded slightly differently; however, the process used to reach consensus was the same in both cases. Synopsis In patients with VHD (except moderate to severe mitral stenosis or a mechanical heart valve), ischemic stroke or TIA, and AF, DOACs (dabigatran, rivaroxaban, apixa- ban, and edoxaban) are recommended over warfarin In patients with valvular AF (ie, moderate to severe mitral stenosis or a mechanical heart valve), warfarin is recommended.32,458,464,469 472 Antiplatelet therapy continues to be recommended over warfarin in patients with VHD other than rheumatic mitral disease and ischemic stroke or TIA.9 For patients with prosthetic heart valves, the choice of type of antithrombotic therapy after ischemic stroke or TIA is influenced by the type of valve (bioprosthetic versus mechanical), the timing of the embolic event, prior documented compliance to anti- thrombotic therapy, and assessment of the function of the prosthetic valve.9,33 Indications and timing for surgical interventions in patients with IE and stroke or TIA depend on multiple factors, including recurrent events while on antibiotic therapy, size of the vegetation, and presence of associated intracranial hemorrhage.33,460,464 467 summarizes the recommended antithrombotic regimen in patients with history of ischemic stroke or TIA and dif- ferent VHD conditions. Recommendation-Specific Supportive Text 1. AF is highly prevalent in patients with VHD and represents one of the most important risk fac- tors for ischemic stroke and TIA. 