Antithrombotic Therapy Following Transcatheter Aortic Valve Replacement

Abstract

Due to a large technical improvement in the past decade, transcatheter aortic valve replacement (TAVR) has expanded to lower-surgical-risk patients with symptomatic and severe aortic stenosis. While mortality rates related to TAVR are decreasing, the prognosis of patients is still impacted by ischemic and bleeding complications, and defining the optimal antithrombotic regimen remains a priority. Recent randomized control trials reported lower bleeding rates with an equivalent risk in ischemic outcomes with single antiplatelet therapy (SAPT) when compared to dual antiplatelet therapy (DAPT) in patients without an underlying indication for anticoagulation. In patients requiring lifelong oral anticoagulation (OAC), the association of OAC plus antiplatelet therapy leads to a higher risk of bleeding events with no advantages on mortality or ischemic outcomes. Considering these data, guidelines have recently been updated and now recommend SAPT and OAC alone for TAVR patients without and with a long-term indication for anticoagulation. Whether a direct oral anticoagulant or vitamin K antagonist provides better outcomes in patients in need of anticoagulation remains uncertain, as recent trials showed a similar impact on ischemic and bleeding outcomes with apixaban but higher gastrointestinal bleeding with edoxaban. This review aims to summarize the most recently published data in the field, as well as describe unresolved issues.

Recurrent hypo‐attenuated leaflet thickening after TAVR: Clinical implications

“…4,8 The anticoagulation strategy following TAVR usually consists of indefinite therapy with a single antiplatelet agent. 9 It is evident that anticoagulation interventions serve to mitigate the prevalence of subclinical BPVT. Notably higher rates have been observed among patients treated with dual antiplatelet therapy than those managed with anticoagulants (15% vs. 4%).…”

“…The anticoagulation strategy following TAVR usually consists of indefinite therapy with a single antiplatelet agent 9 . It is evident that anticoagulation interventions serve to mitigate the prevalence of subclinical BPVT.…”

Spontane retroperitoneale und Rektusscheidenhämatome und ihre interventionelle Therapie: ein Review

“…B. nach Implantation eines Medikamenten-beschichteten Stents oder einer Trans-Katheter-Aortenklappen-Intervention (TAVI) 52 . Während ein Absetzen der Medikation bei thrombembolischen Komplikationen nachweislich von erhöhter Mortalität begleitet wird 53 54 , stellen die mit 5–9 % bis zu mehreren Wochen postoperativ auftretenden Blutungen, ebenfalls ein relevantes Mortalitäts-Risiko dar 54 , sodass eine Risiko-adaptierte und individualisierte Antikoagulation in dieser Hoch-Risiko-Gruppe empfohlen wird 54 . Gerade in dieser Risikokonstellation erwarten wir, dass die gering invasiven aber effektiven und vom Gerinnungsstatus weitgehend unabhängigen Embolisationsverfahren eine breitere Anwendung finden werden.…”