Welcome to PACUPod’s PACULit Daily Literature Update. In this episode, Britany and Seth review ENBALV, a phase 3 randomized trial comparing edoxaban to warfarin early after surgical bioprosthetic valve replacement. The study enrolled 410 patients (mean age ~73) within three months of receiving aortic or mitral bioprosthetic valves and randomized them 1:1 to edoxaban or warfarin (target INR 2.0–3.0). The primary outcome was stroke or systemic embolism. Results showed edoxaban 0.5% vs warfarin 1.5% (risk difference −1.03%, 95% CI −4.34% to 1.95%), suggesting comparable efficacy. Major bleeding was numerically higher with edoxaban (4.1% vs 1.0%), though the confidence interval crossed zero. Notably, there were no fatal bleeds or intracranial hemorrhages with edoxaban, while the warfarin group had one fatal intracranial bleed; intracardiac thrombus occurred in 1.0% of warfarin patients but was absent with edoxaban. The open-label design and short three-month follow-up limit definitive safety conclusions, but the trial supports DOACs as feasible alternatives in selected patients. The discussion places ENBALV within the broader DOAC vs warfarin evidence, referencing meta-analyses and related trials (Explore, ENVISAGE-TAVI AF). Practical takeaways include considering fixed DOAC dosing advantages and bleeding risk, the need for individualized patient selection, and the importance of longer-term data to inform guidelines.