A female patient presented with severe, symptomatic aortic stenosis after distant surgical aortic valve replacement and subsequent transcatheter aortic valve implantation 6 years prior. A 23-mm CoreValve Evolut (Medtronic, Dublin, Ireland) was implanted with excellent symptomatic and hemodynamic results. (
Level of Difficulty: Advanced.
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This case highlights the need for clinician awareness of potential bleeding with novel anti-platelet agents and caution with concurrent use of normal doses of aspirin. Clinicians should consider diffuse alveolar hemorrhage as part of the differential diagnosis in patients on antiplatelet therapy who present with hypoxia and hemoptysis [2]. Only low-dose aspirin is recommended as part of DAPT [1,3]. Prasugrel has been associated with a major bleeding rate of 2.2% for all patients with increased risk among the elderly (age greater than
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