No abstract

The development of transcatheter aortic valve implantation has represented one of the greatest advances in the cardiology field in recent years and has changed clinical practice for patients with aortic stenosis. Despite the continuous improvement in operators’ experience and techniques, and the development of new generation devices, thromboembolic and bleeding complications after transcatheter aortic valve implantation remain frequent, and are a major concern due to their negative impact on prognosis in this vulnerable population. In addition, the optimal antithrombotic regimen in this scenario is not known, and current recommendations are mostly empirical and not evidence based. The present review aims to provide an overview of the current status of knowledge, including relevant on-going randomised trials, on antithrombotic treatment strategies after transcatheter aortic valve implantation.

Dual antiplatelet therapy (DAPT) with a P2Y receptor antagonist in addition to aspirin is the antiplatelet treatment of choice in patients undergoing percutaneous coronary intervention. Despite DAPT being one of the most widely investigated treatment strategies in the cardiology field, its optimal duration after coronary stenting remains controversial. The balance between the possible benefit of preventing a thrombotic event and the risk of suffering a bleeding complication due to maintenance of therapy is of critical relevance to determine the duration of DAPT in a given patient. Indeed, extended DAPT is associated with a reduction in non-fatal ischemic outcomes, at the cost of increasing the risk of bleeding events. Of note, several factors related to the patient, the procedure, or the device implanted may influence the ischemic and/or bleeding risk profiles of a given patient. Therefore, it is reasonable to recommend that the decision on DAPT duration should be individualized on a case-to-case basis. This review aims to provide a comprehensive overview of the current status of knowledge on duration of DAPT after coronary stenting, focusing on the evidence provided mainly by randomized clinical trials, as well as to discuss the factors that may influence the individual ischemic and bleeding risk profiles for a given patient, and whether the use of risk scores may inform the decision-making process for determining DAPT duration.