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Antithrombotic Therapy After Transcatheter Aortic Valve Replacement
Paul Guedeney1,2, Roxana Mehran1, Jean-Philippe Collet2
1The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY (P.G., R.M., B.E.C., G.D.D.).
Circulation. Cardiovascular Interventions
|January 12, 2019
Summary
Optimal antithrombotic therapy after transcatheter aortic valve replacement (TAVR) is unclear. Current dual antiplatelet therapy may increase bleeding risk without significant ischemic benefit, necessitating further research.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Transcatheter aortic valve replacement (TAVR) has advanced significantly, expanding indications to lower-risk patients.
- Ischemic/embolic events and major bleeding are critical complications post-TAVR, strongly linked to mortality.
- The optimal antithrombotic strategy following TAVR remains undefined due to a lack of definitive clinical trials.
Purpose of the Study:
- To review the pathophysiological mechanisms underlying post-TAVR complications.
- To provide an updated overview of antithrombotic regimens currently under investigation for TAVR patients.
- To highlight the need for randomized trials to establish evidence-based antithrombotic guidelines.
Main Methods:
- Review of current literature on TAVR outcomes and antithrombotic strategies.
- Discussion of pathophysiological mechanisms driving complications.
- Analysis of ongoing clinical trials evaluating different antithrombotic approaches.
Main Results:
- Dual antiplatelet therapy (DAPT) is currently recommended but associated with increased bleeding risk without clear ischemic advantage.
- Novel antithrombotic agents, including non-vitamin K oral anticoagulants (NOACs) and warfarin, are being investigated.
- Subclinical leaflet thrombosis and atrial fibrillation are key considerations in TAVR antithrombotic management.
Conclusions:
- The optimal antithrombotic regimen post-TAVR requires further elucidation through rigorous clinical trials.
- Balancing the risks of bleeding against the benefits of preventing ischemic events is crucial.
- Future research should focus on personalized antithrombotic strategies for TAVR patients.
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