Larger-scale multicenter observational data will be necessary to achieve adequate statistical power and to clarify whether DOACs can be used safely in patients with congenital heart disease. Multicenter registries such as that for non-VKA anticoagulants for thromboembolic prevention585a are currently ongoing and will provide important and needed data on the safety and efficacy of DOACs for thromboembolic prevention in patients with con- genital heart disease. CLINICAL STATEMENTS AND GUIDELINES Kleindorfer 5.6. Cardiac Tumors Recommendation for Cardiac Tumors Referenced studies that support the recommendation are summarized in online Data Supplement 42. COR LOE Recommendation In patients with stroke or TIA found to have a left-sided cardiac tumor, resection of the tumor can be beneficial to reduce the risk of Synopsis Primary cardiac tumors are uncommon, occurring in 0.02% of people according to a large autopsy series, and the most common primary cardiac tumors are myxoma and fibroelastoma.589 Patients with cardiac tumors are at increased risk for stroke with an over- all rate of embolism of 25% in the largest single- The mechanism of stroke in patients with left-sided cardiac tumors is embolic and can be either embolization of thrombus that has formed on the tumor or embolization of the tumor or piece of the This finding is the basis for recommending antiplatelet or anticoagulation to conservatively man- aged patients. There are no prospective randomized trials of management of patients diagnosed with car- diac tumors after stroke or TIA; however, surgical exci- sion of papillary fibroelastoma has been associated with decreased risk of stroke compared with control subjects in 1 single-center study.592 For patients with metastatic disease to the heart or with right-sided tumors, paradoxical embolism of tumor or venous thrombus through a PFO could occur. Recommendation-Specific Supportive Text 1. 