Medication Management of Patients Undergoing Transcatheter Aortic Valve Replacement

Abstract

Aortic stenosis (AS) is the most common form of valvular heart disease. A detailed diagnostic workup is necessary to promptly stage and classify disease severity to determine optimal management. Medical therapy and valvuloplasty are options that fail to delay or reverse disease progression. Surgical aortic valve replacement (SAVR) is curative but has significant limitations for some patient populations. A newer option, transcatheter aortic valve replacement (TAVR), has become more widely available to patients with intermediate‐ or high‐operative risk. Periprocedural medication management is imperative for successful valve implantation and to minimize adverse events. Stroke remains one of the most common complications of TAVR and is associated with increased mortality. Thus, intra‐ and postprocedural antithrombotic therapy is required, although the regimen that best minimizes thromboembolic events and bleeding complications has yet to be defined. Patients undergoing TAVR with comorbid conditions requiring oral anticoagulation or individuals who develop subvalvular thromboses pose unique challenges. Antiplatelet and anticoagulant therapy should be carefully balanced. This article summarizes key literature supporting the pharmacologic management of patients receiving TAVR.

Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis Complicated by Sigmoid Septum

“…Furthermore, potential nodal blocking agents such as nondihydropyridine calcium-channel blocker, amiodarone or digoxin, were not given to preclude postoperative AV block postoperatively. Our criterion for β-blocker and anti-arrhythmic medications was supported by Kalich et al 17 Single antiplatelet therapy consisting of 100 mg of aspirin or 75 mg of clopidogrel was administered postoperatively to 123 patients (65.1%) and dual antiplatelet therapy using both drugs at the abovedescribed doses to 51 patients (30.2%). Warfarin or a nonvitamin K antagonist oral anticoagulant was administered to the remaining 15 patients (7.9%).…”

Prognostic Impact of Modified H2FPEF Score in Patients Receiving Trans-Catheter Aortic Valve Replacement

“…Catheter ablation for atrial fibrillation may improve atrial function [ 27 ]. Aggressive titration of heart failure medication may optimize post-TAVR hemodynamics [ 28 ].…”

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

“…Indeed, despite unquestionable advantages, TAVR is burdened by many relevant complications, such as paravalvular regurgitation, aortic injury, heart block, vascular access haemorrhages, and thrombosis/embolization of the prothesis. 3 …”

“…Calcific degeneration of valve structure constitutes the most common cause of AS in the Western world, whereas rheumatic AS still remains the main aetiology in developing countries. 3 The pathophysiological mechanisms leading to valve stenosis are considered to be similar to those involved in the development of atherosclerotic plaques, with emerging therapeutic implications. 4 Actually, advanced age, male gender, dyslipidaemia and systemic inflammatory status represents shared risk factors between coronary artery disease and AS.…”