Antithrombotic and antiplatelet therapy in TAVI patients: a fallow field?

Guidelines on antithrombotic therapy after TAVI are scarce and no randomised evaluation has been performed to demonstrate what the best strategy is. Extrapolation from what we know on surgical heart valve replacement is also hazardous as the level of evidence is not very high and the situation, the valves and the patients are different. Patients undergoing TAVI are fragile and at high risk for both bleeding and stroke complications. In addition, the procedure itself may contribute to the occurrence of these complications rendering risk stratification a key step. Improvement in both periprocedural and post-procedural outcome is a major challenge of antithrombotic therapy. The recent release of more potent but also safer antithrombotic therapies is a unique opportunity to sort out what is the best combination for which patient. Our goal is to review the evidence and analyse what are the perspectives in this challenging area.