Key result
Post-TAVR antithrombotic guidelines rely on extrapolated data and lack sufficient evidence to define optimal regimens.
Why the study?
How should antithrombotic therapy be managed in patients undergoing transcatheter aortic valve replacement?
How should antithrombotic therapy be managed in patients undergoing transcatheter aortic valve replacement?
This review highlights the current guidelines and evidence for antithrombotic therapy post-TAVR, noting the insufficient evidence supporting current guideline-mediated therapy and exploring the link between thrombocytopenia and antiplatelet treatments.
Insufficient evidence for post-TAVR antithrombotic regimens warrants cautious guideline application; dedicated RCTs are needed to define optimal therapy.
Transcatheter aortic valve replacement (TAVR) has become the preferred method for management of severe aortic stenosis in patients who are at high and intermediate surgical risk, and has recently gained approval from the Food and Drug Administration in the US for use in patients at low risk for surgery. Thrombocytopenia and thromboembolic events in patients undergoing TAVR is associated with increased morbidity and mortality, and yet there is insufficient evidence supporting the current guideline-mediated therapy for antithrombotics post-TAVR. In this article, the authors review current guidelines for antithrombotic therapy in patients undergoing TAVR, studies evaluating antiplatelet regimens, and studies evaluating the use of platelet function testing after TAVR. They also offer a potential link between thrombocytopenia and antiplatelet treatments in patients undergoing TAVR.
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Grossman et al. (2020) conducted a review in Severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). Antithrombotic therapy was evaluated. Current guidelines for antithrombotic therapy after transcatheter aortic valve replacement are largely extrapolated from other populations, with insufficient evidence to determine the optimal regimen.
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