A 2015 article published by the American College of Cardiology looks at Anticoagulation for Valvular Heart Disease. Surgical repair of VHD with either a mechanical or bioprosthetic valve is a common solution. Thrombotic and embolic complications and anticoagulation-related bleeding are by far the most prevalent contributors to morbidity and mortality after surgery for VHD. Furthermore, the presence of atrial fibrillation, also requires lifelong anticoagulation in the majority of patients. This article looks at the recommendations for use of anticoagulation after valve repair with a mechanical device. Subsequent studies have shown the addition of aspirin to VKA therapy in patients with mechanical valves leads to reduction in risk of thromboembolism and mortality. For bioprosthetic valve replacement the optimal antithrombotic regime is less clear. The article includes recommendations for antithrombotic therapy in patients with bioprosthetic heart valves. Recommendations from the ACC/AHA largely leave the choice of antithrombotic regimen in the setting of bioprosthetic valve replacement up to individual clinicians. Investigators have yet to establish the role for non-VKA oral anticoagulants (NOACs) in the setting of bioprosthetic valve replacement. however, a growing body of literature suggests better safety profiles of the NOACs in head-to-head trials against warfarin for non-valvular atrial fibrillation.