Antithrombotic therapy in patients undergoing transcatheter aortic valve implantation

Area of Science:

• Cardiology
• Interventional Cardiology
• Pharmacology

Background:

• Transcatheter aortic valve implantation (TAVI) is a growing procedure for aortic stenosis.
• Optimal antithrombotic therapy post-TAVI remains debated due to limited robust clinical trial data.
• Current guidelines often extrapolate evidence from other cardiovascular patient populations.

Purpose of the Study:

• To review and synthesize current evidence regarding antithrombotic strategies following TAVI.
• To provide guidance on the use of antiplatelet therapy (APT) and oral anticoagulation (OAC).
• To delineate specific patient scenarios warranting different antithrombotic regimens.

Main Methods:

• Comprehensive literature review of available data on antithrombotic therapy post-TAVI.
• Analysis of clinical practice trends and extrapolation of evidence from other patient cohorts.
• Evaluation of risks and benefits associated with different antithrombotic agents.

Main Results:

• Single antiplatelet therapy (APT) is generally favored over dual APT post-TAVI.
• Dual APT is considered for patients with recent acute coronary syndrome, complex stenting, or specific stroke/atheroma risk factors.
• Vitamin-K antagonist (VKA) monotherapy is indicated for patients with atrial fibrillation or other long-term OAC needs.
• VKA initiation is recommended for clinical valve thrombosis; its role in subclinical leaflet thrombosis is uncertain.
• Direct-acting oral anticoagulants (DOACs) may be used when OAC is indicated and no contraindications exist.

Conclusions:

• Antiplatelet therapy (APT) is a primary consideration post-TAVI, with single APT preferred.
• Specific high-risk conditions may necessitate dual APT or vitamin-K antagonist (VKA) therapy.
• The choice of antithrombotic regimen requires careful patient-specific risk-benefit assessment.