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Review of Bleeding and Thrombotic Risks Associated With Antithrombotic Therapy After Transcatheter Structural Heart
Hideyuki Kawashima1, Yohei Numasawa2, Naoki Hayakawa3
1Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
Insights
Transcatheter structural heart interventions require antithrombotic therapy post-procedure due to thrombi risk. Balancing this therapy against bleeding risk in high-risk patients is a critical challenge.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomaterials
Background:
- Transcatheter structural heart interventions have advanced significantly.
- Device deployment in these procedures leads to thrombus adhesion, necessitating antithrombotic therapy.
- Postprocedural bleeding complications from antithrombotics are a growing concern.
Purpose of the Study:
- To review current antithrombotic strategies after transcatheter structural heart interventions.
- To assess bleeding risk in patients undergoing these procedures.
- To identify challenges in managing antithrombotic therapy for patients with high thrombotic and bleeding risks.
Main Methods:
- Literature review of recent studies on antithrombotic therapy.
- Analysis of bleeding risk assessment tools and outcomes.
- Focus on transcatheter aortic valve replacement, edge-to-edge repair, and left atrial appendage occlusion.
Main Results:
- Antithrombotic therapy is standard but associated with significant bleeding risks.
- Patients often present with coexisting high thrombotic and bleeding risks.
- Optimal antithrombotic regimen balancing efficacy and safety remains challenging.
Conclusions:
- Careful patient selection and risk stratification are crucial for antithrombotic management.
- Further research is needed to optimize antithrombotic strategies for transcatheter structural heart interventions.
- Personalized antithrombotic approaches may mitigate risks in complex patient populations.
Abstract:
Transcatheter structural heart interventions have drastically evolved over the past 2 decades. However, most catheterization procedures require the deployment of devices in the body; therefore, the adhesion of thrombi to those devices is a major problem, resulting in the requirement of a period of postprocedural antithrombotic regimen. However, in recent years, bleeding associated with these antithrombotic therapies has also become a major concern, attracting the attention of investigators. This is complicated by the fact that patients at high thrombotic risk are also at high bleeding risk, making the issue of administrating antithrombotic therapy challenging. The objective of this review was to identify the important issues and summarize the current status of postoperative antithrombotic therapy and assessment of the bleeding risk following transcatheter structural heart interventions such as transcatheter aortic valve replacement, transcatheter edge-to-edge repair, and transcatheter left atrial appendage occlusion.
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