email article Direct oral anticoagulants (DOACs) are getting used off-label with prosthetic heart valves, even mechanical valves in some cases, a national registry showed. At least some valve patients were discharged with a DOAC prescription at 78.6% 0f the 1,092 hospitals and by 59.6% of the 2,731 physicians participating in the Society of Thoracic Surgeons Adult Cardiac Surgery Database from July 2014 through June 2017. For mechanical heart valve recipients, the rate was 1.1% with aortic valve replacement and 1.04% with mitral valve replacement, without significant change over time for either, Ankur Kalra, MD, of the Cleveland Clinic, and colleagues reported in "I am really very surprised that DOACs are being used in mechanical heart valves," commented Deepak Bhatt, MD, MPH, of Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School in Boston, who was not involved with the study.