AF is highly prevalent in patients with VHD and represents one of the most important risk fac- tors for ischemic stroke and TIA. In patients with prior ischemic stroke or TIA and associated AF, the distinction between valvular and nonvalvular AF is crucial because it has important implications in the selection of the optimal oral anticoagula- Valvular AF refers to AF in the context of moderate to severe mitral stenosis or in the presence of any mechanical heart valve.32 It is important to highlight that the term nonvalvular AF does not imply the absence of VHD but only Recommendations for Valvular Disease Continued COR LOE Recommendations CLINICAL STATEMENTS AND GUIDELINES Kleindorfer the absence of moderate to severe mitral stenosis or mechanical heart valves (ie, AF in the setting of bioprosthetic valves, mild mitral stenosis, and any native aortic, pulmonary, or tricuspid valve dis- ease is still considered nonvalvular).32 According to the results of subgroup analyses of RCTs testing DOACs to prevent thromboembolic complications in patients with AF and meta-analyses of random- in patients with VHD except mod- erate to severe mitral stenosis or a mechanical heart valve, ischemic stroke or TIA, and AF, DOACs (apixaban, dabigatran, edoxaban, and rivaroxaban) are recommended over warfarin therapy. anticoagulation with warfarin is recommended with an INR target of 3.0 (range, 2.5 3.5).33,473 The inci- dence of thromboembolism is higher in patients with mechanical prostheses in the mitral compared with the aortic position, and the rate of thrombo- embolism is lower in patients with a higher INR goal. 