Key result
SAPT beats DAPT or OAC as default post-TAVI therapy by reducing bleeding risks.
Why the study?
Large randomised clinical trials evaluating antithrombotic therapy after TAVI were lacking, leading clinical practice to rely on evidence from other populations.
This review outlines tailored antithrombotic strategies post-TAVI, favoring single antiplatelet therapy for most patients and reserving oral anticoagulation for specific indications like atrial fibrillation or clinical valve thrombosis.
Supports single antiplatelet preference post-TAVI to limit bleeding; leaves open optimal regimens for patients with concomitant anticoagulation indications pending RCTs.
This review provides a comprehensive overview of the available data on antithrombotic therapy after transcatheter aortic valve implantation (TAVI). In the absence of large randomised clinical trials, clinical practice is leaning towards evidence reported in other populations. Due to the greater risk of major bleeding associated with oral anticoagulation using a vitamin-K antagonist (VKA), antiplatelet therapy (APT) may be considered as the first-line treatment of patients undergoing TAVI. Overall, single rather than dual APT is preferred. However, dual APT should be considered in patients with a recent acute coronary syndrome (ie, within 6 months), complex coronary stenting, large aortic arch atheromas or previous non-cardioembolic stroke. Monotherapy with VKA should be considered if concomitant atrial fibrillation or any other indication for long-term oral anticoagulation is present. APT on top of VKA seems only reasonable in patients with recent acute coronary syndrome, extensive or recent coronary stenting or large aortic arch atheromas. A direct-acting oral anticoagulant may be considered if oral anticoagulation is indicated in the absence of contraindications. Initiation of VKA is indicated in clinical valve thrombosis, for example, with high transvalvular gradient, whereas the role of VKA in the case of subclinical leaflet thrombosis is currently uncertain.
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Nijenhuis et al. (2019) conducted a review in Transcatheter aortic valve implantation (TAVI). Antithrombotic therapy (antiplatelet therapy, VKA, DOAC) was evaluated. Single antiplatelet therapy is preferred over dual therapy or oral anticoagulation as first-line treatment after TAVI due to bleeding risks, in the absence of specific indications for anticoagulation.
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