Antithrombotic Therapy After Transcatheter Aortic Valve Implantation

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.

Non-Vitamin K Oral Anticoagulant After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

“…In addition, the consequent antithrombotic therapy after TAVR has remained an important issue (Sun et al, 2009;Guedeney et al, 2019). Since thrombosis may originate from the valved stent, bioprosthetic valve, or other related diseases (Trepels et al, 2009;Tay et al, 2011;De Marchena et al, 2015;Piayda et al, 2018;Mangieri et al, 2019;Ranasinghe et al, 2019), there are currently two main antithrombotic strategies, namely, antiplatelet therapy and anticoagulation therapy (Sherwood and Vora, 2018;Lugo et al, 2020).…”

Platelets

“…Antiplatelet therapies developed to help prevent thrombotic events ( 51 ) are not yet known because of wide variations in clinical practice and heterogeneous trial populations. It is also not known whether thromboembolic complications and leaflet thrombosis following TAVR occur predominantly because of platelet- or thrombin-mediated clot formation, which could also alter the strategy of anticoagulation post-procedure ( 52 ). Current U.S. guidelines advocate for dual antiplatelet therapy (aspirin and clopidogrel) for 6 months post-TAVR followed by lifelong aspirin monotherapy in patients with no other indication for anticoagulation (such as atrial fibrillation), or 3 months of anticoagulation with warfarin for patients with low bleeding risk to prevent valve thrombosis ( 53 ).…”

Antithrombotic therapy in patients undergoing transcatheter aortic valve replacement: the complexity of the elderly

“…Anyhow, this field of scientific research is very active and the results of the ongoing trials will help to define the scenario more clearly. 97 The Trial to Assess the Safety and Efficacy of Prophylactic TicagrelOr With Acetylsalicylic Acid Versus CLopidogrel With Acetylsalicylic Acid in the Development of Cerebrovascular EMbolic Events During TAVI (PTOLEMAIOS, NCT02989558) is comparing DAPT with clopidogrel or ticagrelor in addition to acetylsalicylic acid on cerebrovascular events after TAVR, through transcranial Doppler ultrasound. 98 The impact of ticagrelor monotherapy, compared to clopidogrel plus acetylsalicylic acid, after TAVR is under test in the Safety Profile Evaluation of Ticagrelor Alone Compared to a Combination of Lysine Acetylsalicylate-Clopidogrel in the Context of Transcatheter Aortic Valve Implantation (TICTAVI, NCT02817789).…”