A review of antithrombotic therapy for transcatheter aortic valve replacement

Aortic stenosis (AS) is a common valvular pathological finding in older adults. A latent period followed by rapid progression after the onset of symptoms can result in a high rate of death if left untreated. Aortic valve replacement (AVR) remains the standard of care for patients with severe symptomatic AS; however, due to comorbidities and age, patients may be ineligible for surgical AVR. Transcatheter AVR (TAVR) is an alternative treatment for patients with severe symptomatic AS for whom surgery is not an option. The most recent guidelines and consensus statement discussing TAVR support the use of antithrombotic therapy during and after TAVR procedures to prevent thrombotic complications. Intravenous unfractionated heparin titrated to target activated clotting times during the procedure and dual antiplatelet therapy before and after TAVR with aspirin and clopidogrel may be used. However, it is unclear which antithrombotic regimen may provide optimal protection for early and late thrombotic events in patients who undergo TAVR. This review evaluates the current guidelines, trials, and registry data discussing antithrombotic regimens for TAVR.