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An Update on Anti-thrombotic Therapy Following Transcatheter Aortic Valve Implantation: Expert Cardiologist Opinion

Azfar Zaman1,2, Bernard Prendergast3,4, David Hildick-Smith5

  • 1Department of Cardiology, Freeman Hospital Newcastle upon Tyne, UK.

Interventional Cardiology (London, England)
|July 3, 2023
PubMed

Insights

Expert consensus provides guidance on anti-thrombotic therapy after transcatheter aortic valve implantation (TAVI). Recommendations address evidence gaps for patients in sinus rhythm or with atrial fibrillation (AF).

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Practice Guidelines

Background:

  • Transcatheter aortic valve implantation (TAVI) is a key treatment for symptomatic aortic stenosis.
  • Current guidelines lack consensus on optimal anti-thrombotic medication post-TAVI.
  • Balancing bleeding risk with treatment efficacy requires updated evidence-based recommendations.

Purpose of the Study:

  • To establish expert consensus on anti-thrombotic therapy following TAVI.
  • To address evidence gaps in four critical areas: TAVI in sinus rhythm, TAVI with AF, DOACs vs. VKAs, and UK/Ireland specific guidance.
  • To inform clinical decision-making and improve patient outcomes.

Main Methods:

  • A Delphi panel of experts in TAVI and anti-thrombotic therapy was convened.
  • Evidence gaps were identified and discussed across key clinical scenarios.
  • Consensus recommendations were developed based on expert opinion and available evidence.

Main Results:

  • The consensus addresses anti-platelet and/or anti-coagulant therapy strategies.
  • Specific recommendations are provided for TAVI patients with atrial fibrillation (AF).
  • Guidance is offered on the use of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs).

Conclusions:

  • This consensus statement provides evidence-based best practices for anti-thrombotic prescribing post-TAVI.
  • The recommendations aim to optimize treatment by considering patient-specific factors and evolving evidence.
  • Areas requiring further research to refine anti-thrombotic strategies after TAVI are highlighted.

Keywords:
Transcatheter aortic valve implantationanti-coagulationanti-plateletanti-thromboticaortic stenosisexpert consensusrisk assessment

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