Antithrombotic therapy after transcatheter aortic valve replacement: current perspective.

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.