Thrombotic Versus Bleeding Risk After Transcatheter Aortic Valve Replacement

Mangieri, Antonio; Montalto, Claudio; Poletti, Enrico; Sticchi, Alessandro; Crimi, Gabriele; Giannini, Francesco; Latib, Azeem; Capodanno, Davide; Colombo, Antonio

doi:10.1016/j.jacc.2019.08.1032

Cited by 64 publications

(51 citation statements)

References 61 publications

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“…The occurrence of HALT was detected at different time intervals after TAVI (mean: 159 ± 177 days, ranging from 21 to 596 days). In some cases, this finding remains stable; in others, it progresses to thrombosis, and in others, it regresses without specific treatment [17].…”

Section: Frequency Of Sltmentioning

confidence: 98%

“…The majority of the patients are asymptomatic, and the gradient does not change, but D-dimer and N-terminal-pro-Btype natriuretic peptide (NT-proBNP) levels can be abnormal (increased) [16]. According to the most available data, SLT is an imaging finding [17]. Sub-studies of PARTNER 3 (transcatheter aortic valve replacement (TAVR) with balloon expandable valve in low-risk patients) and EVOLUT LOW RISK (TAVR with self expandable valve in low-risk patients) will clarify the relationship between HALT and neurological events [17].…”

Section: Frequency Of Sltmentioning

confidence: 99%

“…According to the most available data, SLT is an imaging finding [17]. Sub-studies of PARTNER 3 (transcatheter aortic valve replacement (TAVR) with balloon expandable valve in low-risk patients) and EVOLUT LOW RISK (TAVR with self expandable valve in low-risk patients) will clarify the relationship between HALT and neurological events [17].…”

Section: Frequency Of Sltmentioning

confidence: 99%

“…There have been hypotheses that SLT may increase the transvalvular gradient, reduce the durability of the prosthesis, and increase the chance of cerebrovascular events. However, these concerns are not based on data with strong scientific evidence [16,17].…”

Section: Frequency Of Sltmentioning

confidence: 99%

“…The majority of the patients are asymptomatic, and the gradient does not change, but D-dimer and N-terminal-pro-B-type natriuretic peptide (NT-proBNP) levels can be abnormal (increased) [ 16 ]. According to the most available data, SLT is an imaging finding [ 17 ].…”

Section: Frequency Of Sltmentioning

confidence: 99%

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The Issue of Subclinical Leaflet Thrombosis After Transcatheter Aortic Valve Implantation

et al. 2020

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Transcatheter aortic valve implantation (TAVI) has been considered an important therapy for the treatment of symptomatic severe aortic stenosis. Although the devices and the techniques have been improved some complications may occur and several issues still need to be addressed. The issue of subclinical leaflet thrombosis (SLT) has been recognized as a complication after TAVI, and its incidence ranges from 0% to 40%. Nowadays, computed tomography is considered as the standard method for diagnosis of SLT. The concept of hypoattenuated leaflet thickening (HALT), reduced leaflet motion (RELM), and hypoattenuation affecting motion (HAM) have been used in this topic. Most patients who had SLT were taking single or dual antiplatelet therapy. In addition, these medications were not effective in resolving this complication after TAVI. However, there is a suggestion that oral anticoagulants have a protective and therapeutic effect. With the increasing use of TAVI, it is necessary to have better knowledge about several aspects of this complication, because it may have impact on prognosis. Therefore, some aspects of SLT diagnosis, management, and prognosis are not yet fully understood.

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Section: Frequency Of Sltmentioning

confidence: 98%

Section: Frequency Of Sltmentioning

confidence: 99%

Section: Frequency Of Sltmentioning

confidence: 99%

Section: Frequency Of Sltmentioning

confidence: 99%

Section: Frequency Of Sltmentioning

confidence: 99%

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The Issue of Subclinical Leaflet Thrombosis After Transcatheter Aortic Valve Implantation

et al. 2020

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Subclinical Leaflet Thrombosis and Anticoagulation After Transcatheter Aortic Valve Replacement

et al. 2022

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IMPORTANCE Subclinical leaflet thrombosis affects approximately 15% of patients after transcatheter aortic valve replacement (TAVR). The pathophysiology and clinical significance of leaflet thrombosis remain incompletely understood. Defining the optimal management strategy in patients who are asymptomatic, including the role for oral anticoagulation (OAC), is a key challenge for the field.OBSERVATIONS Three recent randomized trials have evaluated the role of OAC in patients after TAVR. These studies have confirmed prior observational data suggesting that OAC is effective at prevention of subclinical leaflet thrombosis. Overall, however, OAC does not lead to a clinical benefit over the period studied, and in some patients may be harmful owing to bleeding risk. CONCLUSIONS AND RELEVANCEStrategies for identification of patients in whom the benefit of OAC outweighs the risks are required for optimization of long-term outcome after TAVR. This requires clearer insights into the mechanisms of asymptomatic leaflet thrombosis, its clinical significance, and patient-specific risks of bleeding and structural valve degeneration.

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