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Mechanical Valve with AF — EECC MCQ

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ModerateArrhythmia & ElectrophysiologyMechanical Valve with AFEECC

A 78-year-old man with AF and a mechanical mitral valve (On-X valve) is currently on warfarin with an INR target of 2.5-3.5. He asks whether he can switch to a DOAC for convenience. What is the correct advice?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — DOACs are contraindicated with mechanical heart valves; continue warfarin

Per the 2024 ESC AF Guidelines and 2025 ESC/EACTS VHD Guidelines, DOACs are contraindicated in patients with mechanical heart valves (Class III). The RE-ALIGN trial tested dabigatran in mechanical valve patients and was stopped early due to excess thromboembolic and bleeding events. Warfarin remains the only recommended anticoagulant for mechanical valves.

Reference: ESC (2025): ESC/EACTS Guidelines for the Management of Valvular Heart Disease