Duan L, Doctor JN, Adams JL, et al. - Researchers undertook this retrospective cohort analysis in California to assess ambulatory utilization of direct oral anticoagulants (DOACs) as well as to compare the effectiveness and safety of DOACs vs warfarin among patients with atrial fibrillation (AF) and bioprosthetic heart valves (BHVs). Cases with BHVs and AF managed with warfarin, dabigatran, rivaroxaban or apixaban were selected. There was no significant link between use of DOACs vs warfarin for the primary effectiveness outcome of ischemic stroke, systemic embolism and transient ischemic attack. A lower risk of the primary safety outcome of intracranial hemorrhage, gastrointestinal bleeding, and other bleeds was observed in relation to use of DOACs. In the sensitivity analyses, consistent findings were obtained across multiple subgroups. Overall, use of DOACs for AF in patients with BHVs is supported by these data.