Adjuvant Antithrombotic Therapy in TAVR.

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Medicine

Background:

• Transcatheter aortic valve replacement (TAVR) is a key treatment for severe aortic stenosis.
• Antithrombotic therapies are crucial during and after TAVR to prevent valve thrombosis and cerebrovascular events (CVEs).
• These therapies, however, elevate bleeding risks, necessitating careful management.

Purpose of the Study:

• To review existing clinical data on adjuvant antithrombotic therapies used in TAVR.
• To analyze the balance between preventing thrombotic events and managing bleeding risks associated with these therapies.
• To identify gaps in current knowledge and guide future research in post-TAVR antithrombotic strategies.

Main Methods:

• Review of past and current clinical data on antithrombotic therapies in TAVR.
• Analysis of safety and efficacy of different anticoagulants and antiplatelet agents.
• Evaluation of current guidelines and ongoing studies in the field.

Main Results:

• Bivalirudin is a safe procedural anticoagulation alternative to unfractionated heparin (UFH) during TAVR.
• Evidence guiding post-TAVR antiplatelet and anticoagulant therapy is limited.
• Ongoing studies are investigating various antithrombotic regimens for the post-TAVR setting.

Conclusions:

• Current guidelines recommend UFH for intra-procedural anticoagulation and dual antiplatelet therapy (DAPT) post-TAVR.
• There is a critical need for better understanding and evidence-based guidance on adjuvant antithrombotic therapies after TAVR.
• Results from ongoing clinical trials are essential for developing optimal, evidence-based antithrombotic strategies post-TAVR.