Related Experiment Video
Updated: Oct 25, 2025
06:04
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
276
Antithrombotic Therapy After Transcatheter Aortic Valve Replacement.
Davide Capodanno1, Jean-Philippe Collet2, George Dangas3
1Division of Cardiology, C.A.S.T., Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy.
JACC. Cardiovascular Interventions
|August 6, 2021
Summary
Optimal antithrombotic therapy after transcatheter aortic valve replacement (TAVR) is crucial. For patients without prior anticoagulation needs, single antiplatelet therapy is preferred over dual therapy to minimize bleeding risks. For those requiring anticoagulation, adding antiplatelet therapy increases bleeding.
Area of Science:
- Cardiology
- Vascular Medicine
- Interventional Cardiology
Background:
- Transcatheter aortic valve replacement (TAVR) is a key treatment for severe aortic stenosis.
- TAVR patients often have comorbidities requiring anticoagulation or antiplatelet therapy.
- Balancing thrombotic and bleeding risks post-TAVR is complex.
Purpose of the Study:
- To review current evidence and guidelines for antithrombotic therapy after TAVR.
- To discuss challenges in managing antithrombotic regimens in elderly TAVR patients.
- To explore evolving strategies and future research directions.
Main Methods:
- Literature review of published research and clinical guidelines.
- Analysis of antithrombotic strategies in TAVR patients with and without baseline indications for anticoagulation.
- Evaluation of bleeding and thrombotic event risks associated with different regimens.
Main Results:
- Dual-antiplatelet therapy post-TAVR (without baseline anticoagulation need) increases bleeding risk compared to single-antiplatelet therapy.
- Adding antiplatelet therapy to oral anticoagulation (OAC) in TAVR patients increases bleeding.
- Single-antiplatelet therapy or OAC appear reasonable as standalone strategies.
Conclusions:
- Single-antiplatelet therapy is recommended for TAVR patients without baseline OAC indications.
- For TAVR patients with baseline OAC indications, adjunctive antiplatelet therapy should be used cautiously due to increased bleeding risk.
- Further research is needed to optimize antithrombotic strategies and compare different OAC agents.
Related Concept Videos
01:29Venous Thrombosis III: Interprofessional Care
66
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
66
01:25Aortic Regurgitation III: Medical Management
87
Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
87
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
1.5K
Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
1.5K
01:27Coronary Artery Disease V: Interprofessional Care
74
Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
74
01:26Atherosclerosis III: Management
77
Management of atherosclerosis involves an integrated strategy encompassing pharmacological treatment, surgical interventions, lifestyle changes, and nutrition therapy to address the multifactorial nature of the disease.Pharmacological TherapyA cornerstone of atherosclerosis management is the use of pharmacological agents. Statins, such as atorvastatin, are pivotal in inhibiting HMG-CoA reductase, an enzyme that catalyzes an initial step in cholesterol synthesis in the liver. This reduction in...
77
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
76
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
76