Antithrombotic selection in patients undergoing transcatheter aortic valve replacement

Area of Science:

• Cardiology
• Interventional Cardiology
• Thrombosis Management

Background:

• Transcatheter aortic valve replacement (TAVR) is a growing procedure.
• Optimal antithrombotic therapy post-TAVR remains debated.
• Current guidelines offer limited specific recommendations.

Purpose of the Study:

• To review current evidence on antithrombotic regimens after TAVR.
• To discuss clinical controversies and recommendations.
• To highlight the importance of patient-specific factors.

Main Methods:

• Review of existing clinical trials and guidelines.
• Analysis of antithrombotic strategies in different patient subgroups.
• Comparison of dual antiplatelet therapy, single antiplatelet therapy, warfarin, and direct-acting oral anticoagulants.

Main Results:

• For patients without prior anticoagulation needs, single antiplatelet therapy may reduce bleeding without compromising ischemic protection compared to dual antiplatelet therapy.
• In patients requiring anticoagulation, warfarin plus single antiplatelet therapy is comparable to triple therapy for ischemic events but with less bleeding.
• Warfarin monotherapy further reduces bleeding.
• Apixaban showed promise in atrial fibrillation patients, but routine rivaroxaban use raised concerns.

Conclusions:

• There is no consensus on the ideal antithrombotic regimen post-TAVR.
• Therapy selection must balance thrombotic and bleeding risks based on individual patient factors and comorbidities.
• Further research is needed to clarify the role of DOACs.