Antithrombotic Management for Transcatheter Aortic Valve Implantation.

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Pharmacology

Background:

• Significant shifts in optimal antithrombotic regimens following transcatheter aortic valve implantation (TAVI) have occurred.
• Recent major clinical trials have reshaped evidence-based recommendations for post-TAVI antithrombotic therapy.

Purpose of the Study:

• To provide a narrative review of key clinical trials influencing antithrombotic strategies post-TAVI.
• To summarize current guideline recommendations and identify knowledge gaps in post-TAVI antithrombotic management.

Main Methods:

• A narrative description of major clinical trials was conducted.
• PubMed was utilized to identify relevant trials using keywords such as "transcatheter aortic valve replacement," "transcatheter aortic valve implantation," "antithrombotic," "antiplatelet," and "anticoagulation."
• This study is a narrative review, not a systematic review or meta-analysis.

Main Results:

• Major trials (POPULAR-TAVI A/B, ENVISAGE-TAVI AF, GALILEO, ATLANTIS, ADAPT-TAVR) inform current practice.
• Single antiplatelet therapy is recommended for most patients post-TAVI without other anticoagulation needs.
• Dual antiplatelet therapy may be considered for younger patients with high thrombotic and low bleeding risks.

Conclusions:

• Single antiplatelet therapy is the recommended antithrombotic strategy for the majority of patients post-TAVI.
• Management should be individualized based on bleeding and thrombotic risk, especially in younger patients.