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Antithrombotic therapy after transcatheter aortic valve replacement: current perspective.

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For transcatheter aortic valve replacement (TAVR), aspirin or anticoagulation monotherapy appears to balance antithrombotic protection and bleeding risk, avoiding potent regimens with higher bleeding rates.

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Biomaterials

Background:

  • Transcatheter aortic valve replacement (TAVR) is increasingly used for severe aortic stenosis across all risk groups.
  • Post-TAVR management focuses on balancing thrombotic and bleeding risks.
  • High-resolution CT can detect leaflet dysfunction and thrombi post-TAVR.

Purpose of the Study:

  • To review patient and procedural factors influencing antithrombotic therapy choice post-TAVR.
  • To update on recent developments in post-TAVR antithrombotic management.
  • To guide optimal antithrombotic strategies balancing efficacy and safety.

Main Methods:

  • Review of current literature and randomized clinical trials on antithrombotic therapy post-TAVR.
  • Analysis of factors contributing to ischemic and bleeding complications.
  • Evaluation of evidence for different antithrombotic regimens.

Main Results:

  • High incidence of ischemic and bleeding complications observed post-TAVR.
  • Dual antiplatelet therapy (DAPT) and oral anticoagulation (OAC) plus antiplatelet therapy increase bleeding risk.
  • Aspirin monotherapy or OAC monotherapy may offer a better balance of protection and risk.

Conclusions:

  • Variable guidelines exist for post-TAVR antithrombotic therapy.
  • Potent antithrombotic regimens increase bleeding without clear clinical benefit.
  • A conservative approach favoring aspirin or OAC monotherapy is recommended, tailored to individual thromboembolic risk.