Antithrombotic Therapy in Transcatheter Aortic Valve Replacement

Valvo, Roberto; Costa, Giuliano; Tamburino, Corrado; Barbanti, Marco

doi:10.3389/fcvm.2019.00073

Cited by 3 publications

(3 citation statements)

References 44 publications

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“…On the basis of the mechanisms surrounding thrombotic complications, both antiplatelet agents and OACs deserve consideration (Figure 1), with triple therapy representing a very questionable option. 13,77 Up to two-thirds of patients currently receive a combination of OAC and antiplatelet therapy, but this seems to lead to a substantial increase in the composite of major or life-threatening bleeding. 78 This practice is derived from analogy with percutaneous coronary intervention, considering the lack of high-grade guideline recommendations and the high prevalence of coronary or peripheral artery disease among TAVI patients.…”

Section: Anticoagulant Therapy After Transcatheter Aortic Valve Implamentioning

confidence: 99%

Anticoagulation after Transcatheter Aortic Valve Implantation: Current Status

Greco

Capodanno

2020

Interv Cardiol

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Transcatheter aortic valve implantation (TAVI) is the standard of care for symptomatic severe aortic stenosis. Antithrombotic therapy is required after TAVI to prevent thrombotic complications but it increases the risk of bleeding events. Current clinical guidelines are mostly driven by expert opinion and therefore yield low-grade recommendations. The optimal antithrombotic regimen following TAVI has yet to be determined and several randomised controlled trials assessing this issue are ongoing. The purpose of this article is to critically explore the impact of antithrombotic drugs, especially anticoagulants, on long-term clinical outcomes following successful TAVI.

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Section: Anticoagulant Therapy After Transcatheter Aortic Valve Implamentioning

confidence: 99%

Anticoagulation after Transcatheter Aortic Valve Implantation: Current Status

Greco

Capodanno

2020

Interv Cardiol

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“…atrial fibrillation (AF), hypertension, diabetes] which represent risk factors for ischaemic and embolic events per se . 14 …”

Section: Cerebrovascular Complications In Tavrmentioning

confidence: 99%

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

Bencivenga

Sepe

Palaia

et al. 2020

European Journal of Preventive Cardiology

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Along with epidemiologic transitions of the global population, the burden of aortic stenosis (AS) is rapidly increasing and transcatheter aortic valve replacement (TAVR) has quickly spread; indeed, it is nowadays also employed in treating patients with AS at intermediate operative risk. Nonetheless, the less invasive interventional strategy still carries relevant issues concerning post-procedural optimal antithrombotic strategy, given the current indications provided by guidelines are not completely supported by evidence-based data. Geriatric patients suffer from high bleeding and thromboembolic risks, whose balance is particularly subtle due to the presence of concomitant conditions, such as atrial fibrillation and chronic kidney disease, that make the post-TAVR antithrombotic management particularly insidious. This scenario is further complicated by the lack of specific evidence regarding the ‘real-life’ complex conditions typical of the geriatric syndromes, thus, the management of such a heterogeneous population, ranging from healthy ageing to frailty, is far from being defined. The aim of the present review is to summarize the critical points and the most updated evidence regarding the post-TAVR antithrombotic approach in the geriatric population, with a specific focus on the most frequent clinical settings.

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“…The different strategies consist of either single antiplatelet therapy (SAPT) or double antiplatelet therapy (DAPT), or oral anticoagulation therapy (OAC) [42]. When there is no known indication for oral anticoagulation, such as pre-existing atrial fibrillation, SAPT is preferred to DAPT to minimize bleeding risk [42,43]. However, other studies have contradicted this recommendation by showing that patients with NOAF discharged with SAPT showed a higher rate of mortality and that this population specifically would benefit from a more aggressive antithrombotic therapy [39].…”

Section: Managementmentioning

confidence: 99%

A Review of the Incidence and Management of New-Onset Atrial Fibrillation Post Transcatheter Aortic Valve Implantation

Saxena¹

2020

AJBSR

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Transcatheter Aortic Valve Implantation (TAVI) is an established treatment option for patients with aortic stenosis who are considered highrisk for surgical valve replacement. New-onset atrial fibrillation (NOAF) is a serious adverse event post TAVI that is predictive of poor outcomes and whose pathophysiology remains unclear. The incidence of NOAF post-TAVI has a reportedly broad range depending on the study but has been correlated to procedure approach, choice of valve, and the use of general anesthesia. While surgical aortic valve replacement (SAVR) has traditionally been the preferred treatment for aortic stenosis, recent studies have demonstrated the benefits of expanding TAVI into a larger patient population. Additionally, the management of NOAF post-TAVI remains highly variable. This review paper aims to summarize the incidence of NOAF and to outline management strategies.The risk factors for NOAF post-TAVI is an ongoing area of research with many questions remaining to be answered. With the expansion of TAVI into lower-risk patient populations, it is imperative that risk factors for NOAF be determined in order to decrease the likelihood of stroke and mortality after the procedure. Data is still limited on standardized treatment for NOAF, but multiple international drug trials are aiming to discern the optimal anti-platelet and anti-coagulation treatment to improve post-procedure outcomes.

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Antithrombotic Therapy in Transcatheter Aortic Valve Replacement

Cited by 3 publications

References 44 publications

Anticoagulation after Transcatheter Aortic Valve Implantation: Current Status

Anticoagulation after Transcatheter Aortic Valve Implantation: Current Status

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

A Review of the Incidence and Management of New-Onset Atrial Fibrillation Post Transcatheter Aortic Valve Implantation

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