The 2025 ESC Guidelines on valvular heart disease emphasize individualized, patient-centered antithrombotic management, integrating thrombotic and bleeding risk, valve type, comorbidities, and, for the first time, patient engagement in a Class I recommendation. Education is recommended for all patients on oral anticoagulation, and INR self-monitoring or self-management is advised in selected, trained patients to improve therapy efficacy. Routine DAPT after valve procedures is discouraged, and anticoagulation is guided by clinical indication. Mechanical valves require lifelong vitamin-K antagonists; DOACs are contraindicated. For bioprosthetic surgical valves, early postoperative anticoagulation (VKA or short-term OAC/antiplatelet) is individualized. After TAVI, low-dose aspirin is preferred unless an independent OAC indication exists (e.g., atrial fibrillation). DOACs are supported where evidence exists but remain contraindicated in mechanical valves and certain rheumatic lesions. Measurement of anticoagulant levels and individualized peri-procedural timing remain important in complex cases. Evidence gaps, particularly regarding DOAC use after bioprosthetic valves and optimal therapy duration, are highlighted as research priorities.