Pharmacology in Structural Intervention for Valvular Heart Disease: Current Practice and Future Perspectives

Figures

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  Figure 1. Potential factors influencing bleeding and thromboembolic complications during and after transcatheter aortic valve implantation. Abbreviations: AF, atrial fibrillation; CKD, chronic kidney disease.

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  Figure 2. Clinical trials of antithrombotic therapy for transcatheter aortic valve replacement patients with no need for chronic anticoagulation (Part 1). Abbreviations: ARTE, Aspirin Versus Aspirin and Clopidogrel Following TAVR; ASA, aspirin; CV, cardiovascular; DAPT, dual antiplatelet therapy; GALILEO, Global Study Comparing a Rivaroxaban-Based Antithrombotic Strategy to an Antiplatelet-Based Strategy After TAVR to Optimize Clinical Outcomes; MI, myocardial infarction; POPular TAVI, Antiplatelet Therapy for Patients Undergoing TAVR; SAT-TAVI, Single Antiplatelet Therapy for TAVR; TAVR, transcatheter aortic valve replacement.

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  Figure 3. Clinical trials of antithrombotic therapy for transcatheter aortic valve replacement patients with no need for chronic anticoagulation (Part 2).∗ Primary endpoint is ≥1 prosthetic leaflet with >50% RLM or HALT grade ≥4, detected on 4D CT imaging Abbreviations: ADAPT TAVR, Anticoagulation Versus Dual Antiplatelet Therapy for Prevention of Leaflet Thrombosis and Cerebral Embolization After Transcatheter Aortic Valve Replacement; ASA, aspirin; ATLANTIS, Antithrombotic Strategy to Lower All Cardiovascular and Neurologic Ischemic and Hemorrhagic Events After TAVR for Aortic Stenosis; CT, computed tomography; CV, cardiovascular; DAPT, double antiplatelet therapy; GALILEO, Global Study Comparing a Rivaroxaban-Based Antithrombotic Strategy to an Antiplatelet-Based Strategy After TAVR to Optimize Clinical Outcomes; HALT, hypoattenuated leaflet thickening; MRI, magnetic resonance imaging; RLM, reduced leaflet motion; SAPT, single antiplatelet therapy; TAVR, transcatheter aortic valve replacement.

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  Figure 4. This figure summarizes the results of the OCEAN-TAVI registry showing no difference in terms of NACE or major bleedings in patients not undergoing antithrombotic regimen. ∗NACE: net adverse clinical events defined as a composite of cardiovascular death, stroke, myocardial infarction, and life-threatening or major bleeding Abbreviations: ASA, aspirin; DAPT, double antiplatelet therapy; OCEAN TAVI, Optimized transCathEter vAlvular iNtervention; SAPT, single antiplatelet therapy.

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  Figure 5. Clinical trials of antithrombotic therapy for transcatheter aortic valve replacement patients with concurrent need for chronic anticoagulation. ∗Composite of death, MI, stroke, or transient ischemic attack, noncentral nervous system embolism, pulmonary embolism, intracardiac or valve thrombosis, deep vein thrombosis, and life-threatening, disabling, or major bleeding. ∗∗ Composite of all-cause death, MI, ischemic stroke, systemic thromboembolism, valve thrombosis, or major bleeding Abbreviations: ATLANTIS, Antithrombotic Strategy to Lower All Cardiovascular and Neurologic Ischemic and Hemorrhagic Events After TAVR for Aortic Stenosis; CV, cardiovascular; ENVISAGE-TAVI AF, Edoxaban Versus Vitamin K Antagonists After TAVR in Patients with Atrial Fibrillation; GI, gastro-intestinal; MI, myocardial infarction; OAC, anticoagulation; POPular TAVI, Antiplatelet Therapy for Patients Undergoing TAVR; TAVR, transcatheter aortic valve replacement; VKA, vitamin K antagonist.