Thrombogenicity and Antithrombotic Strategies in Structural Heart Interventions and Nonaortic Cardiac Device...

Area of Science:

• Cardiology
• Interventional Cardiology
• Thrombosis Research

Background:

• Increasing rates of structural heart interventions worldwide necessitate improved secondary prevention strategies.
• Current recommendations for preventing device thrombosis are largely empiric.
• Device-related thrombosis poses a significant risk following cardiac device implantation.

Purpose of the Study:

• To review the mechanisms of device-related thrombosis.
• To evaluate existing evidence on antithrombotic regimens post-cardiac device implantation.
• To propose an algorithm for identifying thrombogenicity risk factors and managing device thrombosis for specific devices.

Main Methods:

• Literature review of mechanisms and evidence for antithrombotic therapy.
• Development of a risk stratification and management algorithm.
• Focus on patent foramen ovale occluders, left atrial appendage occluders, MitraClips, transcatheter mitral valve replacement, pacemaker leads, and left ventricular assist devices.

Main Results:

• Discussion of underlying mechanisms contributing to device thrombosis.
• Synthesis of current evidence on antithrombotic strategies.
• Presentation of a practical algorithm for clinical decision-making.

Conclusions:

• Effective secondary prevention is vital for patients undergoing structural heart interventions.
• The proposed algorithm aids in personalized risk assessment and management of device thrombosis.
• Further research may refine antithrombotic strategies for various cardiac devices.