Antithrombotic Therapy Following Transcatheter Aortic Valve Replacement

Area of Science:

• Cardiology
• Interventional Cardiology
• Thrombosis

Background:

• Transcatheter aortic valve replacement (TAVR) is increasingly used in lower-risk patients with severe aortic stenosis.
• Ischemic and bleeding complications remain significant concerns impacting TAVR patient outcomes.
• Defining the optimal antithrombotic strategy post-TAVR is a critical clinical challenge.

Purpose of the Study:

• To review recent evidence on antithrombotic regimens following TAVR.
• To summarize updated guideline recommendations for TAVR patients.
• To highlight unresolved questions regarding anticoagulation strategies post-TAVR.

Main Methods:

• Review of recent randomized controlled trials (RCTs) and guideline updates.
• Analysis of antithrombotic strategies including single antiplatelet therapy (SAPT), dual antiplatelet therapy (DAPT), and oral anticoagulation (OAC).
• Comparison of outcomes (ischemic and bleeding events) across different antithrombotic regimens.

Main Results:

• SAPT showed lower bleeding rates than DAPT with similar ischemic outcomes in patients without an indication for OAC.
• Combining OAC with antiplatelet therapy in TAVR patients increased bleeding risk without improving mortality or ischemic outcomes.
• Recent guidelines recommend SAPT for TAVR patients without OAC indication and OAC alone for those with a long-term OAC need.

Conclusions:

• Current evidence supports a shift towards less intensive antiplatelet therapy post-TAVR in select patient groups.
• The choice between DOACs and VKAs for TAVR patients requiring anticoagulation requires further investigation.
• Ongoing research is needed to refine antithrombotic strategies and address specific patient populations post-TAVR.