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Antithrombotic Therapy for Transcatheter Valvular Interventions: A Revisit
Shaban Mohammed1, Ayman El-Menyar2,3, Haifa Al-Janubi1
1Clinical Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
Current Vascular Pharmacology
|April 11, 2017
Summary
Optimal antithrombotic therapy for transcatheter aortic valve implantation (TAVI) and MitraClip procedures remains unclear. This review examines antithrombotic strategies to balance risks of stroke and bleeding in patients undergoing these revolutionary cardiac interventions.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
- Pharmacology
Background:
- Transcatheter aortic valve implantation (TAVI) and MitraClip implantation are transformative treatments for valvular heart disease.
- Optimal antithrombotic strategies for these procedures are not well-established.
- TAVI carries risks of cerebral embolization and ischemic events, impacting neurological function.
Purpose of the Study:
- To review current literature on antithrombotic therapy for TAVI and MitraClip.
- To highlight the benefits and drawbacks of antithrombotic use in these catheter-based interventions.
- To inform the development of optimal antithrombotic regimens.
Main Methods:
- A narrative review of studies published between January 2002 and May 2016.
- Analysis of antithrombotic therapy in the context of transcatheter valvular interventions.
- Examination of existing data on TAVI and MitraClip antithrombotic use.
Main Results:
- Current antithrombotic therapies for TAVI and MitraClip lack established optimal protocols.
- Variable rates of ischemic complications, including neurological impairment, are associated with TAVI.
- Balancing antithrombotic efficacy against bleeding risk is a critical challenge.
Conclusions:
- Consensus is needed on the timing, combination, and duration of antithrombotic medications.
- Optimal therapy must balance ischemic and hemorrhagic complications.
- Further research is required to define best practices for antithrombotic management in transcatheter valvular interventions.
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