AREVA: multicenter randomized comparison of low-dose versus standard-dose anticoagulation in patients with mechanical prosthetic heart valves. Circulation. 1996;94:2107 12. CLINICAL STATEMENTS AND GUIDELINES S4.1.1-17. Hering D, Piper C, Bergemann R, et al. Thromboembolic and bleeding complications following St. Jude Medical valve replace- ment: results of the German Experience With Low-Intensity Anticoagulation Study. Chest. 2005;127:53 9. S4.1.1-18. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guide- line for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129: e521 643. S4.1.1-19. Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017;135:e1159 95. S4.1.1-20. Ahmad Y, Lip GYH, Apostolakis S. New oral anticoagulants for stroke prevention in atrial fibrillation: impact of gender, heart fail- ure, diabetes mellitus and paroxysmal atrial fibrillation. Expert Rev Cardiovasc Ther. 2012;10:1471 80. S4.1.1-21. Chiang C-E, Naditch-Br l L, Murin J, et al. Distribution and risk profile of paroxysmal, persistent, and permanent atrial fibrillation in routine clinical practice: insight from the real-life global survey evaluating patients with atrial fibrillation international registry. Circ Arrhythm Electrophysiol. 2012;5:632 9. S4.1.1-22. Flaker G, Ezekowitz M, Yusuf S, et al. Efficacy and safety of dabiga- tran compared to warfarin in patients with paroxysmal, persistent, and permanent atrial fibrillation: results from the RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy) study. J Am Coll Cardiol. 2012;59:854 5. S4.1.1-23. Hohnloser SH, Duray GZ, Baber U, et al. Prevention of stroke in patients with atrial fibrillation: current strategies and future direc- tions. Eur Heart J. 2007;10:H4 10. S4.1.1-24. 