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Antithrombotic Treatment After Valve-in-Valve, Valve-in-Ring, and Valve-in-MAC Procedures: A Systematic Review and

Gonçalo Terleira Batista1, Gonçalo Costa2, Joana Delgado Silva2

  • 1Serviço de Cardiologia. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal.

Acta Medica Portuguesa
|July 21, 2025
PubMed

Insights

Anticoagulation may reduce valve thrombosis after valve-in-valve, valve-in-ring, and valve-in-mitral annular calcification procedures. Further research is needed due to limited data on bleeding and mortality.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Biomaterials Science

Background:

  • Limited evidence exists on optimal antithrombotic therapy post-valve-in-valve (ViV), valve-in-ring (ViR), and valve-in-mitral annular calcification (ViMAC) procedures.
  • Increased risk of thrombosis observed in ViV interventions necessitates further investigation.
  • Current antithrombotic strategies require optimization for these specific transcatheter valve procedures.

Purpose of the Study:

  • To systematically review the potential benefits of anticoagulation versus antiplatelet therapy in ViV, ViR, and ViMAC procedures.
  • To assess the efficacy and safety of different antithrombotic strategies in patients undergoing these interventions.
  • To identify gaps in current research regarding antithrombotic management for complex valve interventions.

Main Methods:

  • Systematic search of PubMed, Embase, Cochrane Central Register, and grey literature up to December 2023.
  • Inclusion of observational and interventional studies with comparative analysis of antithrombotic strategies.
  • Primary endpoints: clinical and total valve thrombosis (VT); safety endpoint: major bleeding. Analysis of mitral position valves and valve types.

Main Results:

  • Included five observational studies and one case series (1082 participants).
  • Anticoagulation associated with significantly lower clinical VT (1.1% vs 8.3%) and total VT (1.3% vs 8.5%) rates compared to antiplatelets.
  • Data on bleeding events was insufficient for thorough analysis.

Conclusions:

  • Anticoagulation regimens show potential benefit in reducing high valve thrombosis rates after ViV, ViR, and ViMAC procedures.
  • Lack of randomized controlled trials and comprehensive bleeding/mortality data highlights the need for further investigation.
  • Future research should focus on randomized trials to establish optimal antithrombotic strategies and safety profiles.
Abstract

Keywords:
Anticoagulants/administration & dosageBioprosthesisCardiac CatheterizationHeart Valve ProsthesisHeart Valve Prosthesis ImplantationThrombosis/prevention & control

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