Dual antiplatelet therapy post-transcatheter aortic valve replacement may accelerate subclinical leaflet thrombosis, a condition that develops in 15% of patients and restricts leaflet mobility.
Systematic Review
Does dual antiplatelet therapy affect the progression of subclinical leaflet thrombosis and leaflet mobility in patients post-TAVR?
Routine use of dual antiplatelet therapy post-TAVR may accelerate subclinical leaflet thrombosis and impair leaflet mobility, suggesting a need to re-evaluate optimal antithrombotic strategies.
Objective: Subclinical leaflet thrombosis (SLT) develops in 15% of patients undergoing trans-catheter aortic valve replacement (TAVR). TAVR is a procedure in which a faulty aortic valve is replaced with a mechanical one. An aortic valve replacement can be done with open-heart surgery; this is called surgical aortic valve replacement (SAVR). A significant problem is defining the best course of treatment for asymptomatic individuals with SLT post-TAVR, including the use of oral anticoagulation (OAC) in it. Study design: Systematic review. Method: The most pertinent published research (original papers and reviews) in the scientific literature were searched for and critically assessed using the online, internationally indexed databases PubMed, Medline, and Cochrane Reviews. Keywords like "Transcatheter valve replacement" and "Subclinical leaflet thrombosis" were used to search the papers. Selected studies were critically assessed for inclusion based on predefined criteria. Results: The review examined the prevalence and characteristics of SLT after TAVR. To note, the incidence of SLT is seen to be higher in TAVR compared SAVR. Dual antiplatelet therapy, which is utilized in antithrombotic regimens post-TAVR, can possibly hasten SLT progression which could result in the impaired mobility of leaflets and the worsening of pressure gradients. Conclusion: The use of dual antiplatelet drugs in routine antithrombotic therapy tends to accelerate initial subclinical leaflet thrombosis after TAVI, which results in a developing restriction of leaflet mobility and an increase in pressure differences.
Shashank et al. (2024) conducted a systematic review in Subclinical leaflet thrombosis post-transcatheter aortic valve replacement. Dual antiplatelet therapy was evaluated on Subclinical leaflet thrombosis progression and leaflet mobility. Dual antiplatelet therapy post-transcatheter aortic valve replacement may accelerate subclinical leaflet thrombosis, a condition that develops in 15% of patients and restricts leaflet mobility.