Antithrombotic Therapy after Structural Heart Disease Intervention

Area of Science:

• Cardiology
• Interventional Cardiology
• Pharmacology

Background:

• Structural heart disease interventions like TAVI, TEER, PFO closure, and LAAC are advancing patient care.
• Antithrombotic therapy post-procedure presents a challenge, requiring a balance between preventing clots and minimizing bleeding risk.
• Optimal antithrombotic strategies are still evolving despite existing evidence.

Purpose of the Study:

• To review and synthesize current evidence on antithrombotic therapy following structural heart interventions.
• To analyze the impact of different antithrombotic regimens on clinical outcomes, including stroke, embolism, device thrombosis, and bleeding.
• To provide insights into evolving guidelines and best practices for post-procedural antithrombotic management.

Main Methods:

• Comprehensive review of randomized controlled trials, observational studies, and clinical guidelines published between 2015 and 2025.
• Focus on post-procedural antithrombotic regimens: single antiplatelet therapy (SAPT), dual antiplatelet therapy (DAPT), and oral anticoagulation.
• Evaluation of outcomes such as stroke, systemic embolism, device-related thrombosis, and major bleeding events.

Main Results:

• Transcatheter aortic valve implantation (TAVI): Trend towards SAPT over DAPT due to similar efficacy and reduced bleeding.
• Transcatheter edge-to-edge repair (TEER): Less standardized; anticoagulation for atrial fibrillation, antiplatelet therapy for sinus rhythm.
• Patent foramen ovale (PFO) closure: Typically 3-6 months DAPT followed by SAPT.
• Left atrial appendage closure (LAAC): Initial anticoagulation plus antiplatelet therapy, transitioning to SAPT.
• Bleeding risk is a key factor, especially in elderly and comorbid patients.

Conclusions:

• Individualized antithrombotic therapy is crucial, considering procedure type, patient factors, and bleeding risk.
• Simplified regimens, particularly SAPT, are increasingly supported for TAVI and other interventions.
• Further randomized trials are needed to optimize antithrombotic strategies.
• Balancing thromboembolic prevention and bleeding avoidance remains paramount for successful structural heart interventions.