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Thrombotic Versus Bleeding Risk After Transcatheter Aortic Valve Implantation.

Kotsi Sofia Fotoula1, Abdalazeem Ibrahem1,2, Allam Harfoush1,3

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Summary

Optimal antithrombotic therapy after transcatheter aortic valve implantation (TAVI) balances bleeding and clotting risks. Current evidence supports single antiplatelet therapy or oral anticoagulation alone based on patient indications, avoiding routine use in unselected patients.

Keywords:
antithrombotic therapyaortic stenosisbleeding riskleaflet thrombosisthrombotic complicationstranscatheter aortic valve implantation (TAVI)

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Pharmacology

Background:

  • Transcatheter aortic valve implantation (TAVI) use is rising across all risk groups, leading to more long-term patients with bioprosthetic valves.
  • These patients are often multimorbid, increasing vulnerability to thrombotic and bleeding complications.
  • Optimal antithrombotic therapy post-TAVI remains unclear due to varied trial designs and patient populations.

Purpose of the Study:

  • To review current evidence on antithrombotic strategies following TAVI.
  • To evaluate antiplatelet and anticoagulant therapies, bleeding/thrombotic predictors, and emerging personalized risk stratification methods.
  • To provide guidance on optimal post-TAVI antithrombotic management.

Main Methods:

  • Narrative review of randomized controlled trials, observational studies, biomarker research, and guidelines.
  • Evaluation of evidence for antiplatelet and anticoagulant strategies.
  • Analysis of predictors for bleeding and thrombotic complications.

Main Results:

  • Thrombotic events are mainly early and procedural; new atrial fibrillation (AF) increases late risk.
  • Subclinical leaflet thrombosis is common but its clinical impact and the benefit of anticoagulation are uncertain.
  • Early bleeding is a major mortality factor; minimalist, indication-driven regimens (single antiplatelet or OAC monotherapy) are supported by evidence.

Conclusions:

  • Post-TAVI antithrombotic strategies must balance bleeding minimization with thromboembolic protection.
  • Single antiplatelet therapy (no OAC indication) or OAC alone (with AF) offers the best safety/efficacy.
  • Future strategies may involve imaging, biomarkers, and machine learning for personalized risk assessment.