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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
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Antithrombotic Therapy in Patients Undergoing Transcatheter Interventions for Structural Heart Disease
Paolo Calabrò1,2, Felice Gragnano1,2, Giampaolo Niccoli3,4,5
1Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy (P.C., F.G., E.M., A.C.).
Circulation
|October 18, 2021
Summary
Balancing antithrombotic therapy for transcatheter structural heart interventions is complex. This review highlights evidence for preventing clots while minimizing bleeding risks in these procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Medicine
Background:
- Device-based transcatheter interventions are increasingly used for structural heart disease.
- Procedures include aortic valve implantation, mitral/tricuspid valve repair/implantation, left atrial appendage occlusion, and patent foramen ovale closure.
- These interventions necessitate antithrombotic therapy to prevent thromboembolic events.
Purpose of the Study:
- To review current evidence on antithrombotic therapies for device-based transcatheter interventions.
- To emphasize the challenges in balancing thrombotic and bleeding risks.
- To highlight the need for tailored antithrombotic regimens based on specific procedures.
Main Methods:
- Systematic review of contemporary evidence.
- Analysis of antithrombotic strategies in various transcatheter structural interventions.
- Discussion of clinical indications and procedural aspects influencing therapy.
Main Results:
- Antithrombotic therapy is crucial but carries bleeding risks.
- Optimal antithrombotic regimens remain unclear and procedure-dependent.
- A personalized approach is essential for managing thrombotic and bleeding risks.
Conclusions:
- Evidence supports device-based transcatheter interventions for structural heart disease.
- Careful consideration of antithrombotic therapy is vital to optimize patient outcomes.
- Tailored antithrombotic strategies are necessary to balance efficacy and safety.
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