Subclinical leaflet thrombosis occurs in 10% to 15% of patients at 1 month and up to 30% by 1 year after TAVR, and while oral anticoagulation reduces imaging-detected thrombosis, it increases bleeding and mortality.
This state-of-the-art review integrates device geometry, sinus flow dynamics, and native tissue activity to inform personalized anticoagulation strategies for managing subclinical leaflet thrombosis after TAVR.
Subclinical leaflet thrombosis (SLT) following transcatheter aortic valve replacement occurs in 10% to 15% of patients at 1 month and up to 30% by 1 year, extending to perivalvular structures as subclinical aortic valve-complex thrombosis. We review contributing factors to SLT, including valve-specific parameters such as flow dynamics in the native sinus and neosinus, prosthesis sizing, deployment symmetry, implant depth, and commissural alignment; the persistent metabolic activity of retained calcified leaflets; and the impact of antithrombotic therapy on SLT incidence. Although oral anticoagulation reduces imaging-detected SLT, it increases bleeding and mortality. This review offers a comprehensive analysis integrating device geometry, sinus flow dynamics, and native tissue activity to inform personalized, time-limited anticoagulation strategies in high-risk patients, thereby optimizing the thrombosis-bleeding balance and enhancing transcatheter aortic valve replacement outcomes.
Marchandot et al. (Thu,) conducted a review in Subclinical leaflet thrombosis and subclinical aortic valve complex thrombosis following TAVR. Antithrombotic therapy was evaluated. Subclinical leaflet thrombosis occurs in 10% to 15% of patients at 1 month and up to 30% by 1 year after TAVR, and while oral anticoagulation reduces imaging-detected thrombosis, it increases bleeding and mortality.