Key result
Subclinical leaflet thrombosis occurs in 0% to 40% of patients after transcatheter aortic valve implantation, and oral anticoagulants appear more effective than antiplatelet therapy for its prevention and treatment.
Why the study?
With the increasing use of TAVI, better knowledge about subclinical leaflet thrombosis is needed because several aspects of its diagnosis, management, and impact on prognosis are not fully understood.
Do oral anticoagulants prevent or resolve subclinical leaflet thrombosis better than antiplatelet therapy in patients after TAVI?
Do oral anticoagulants prevent or resolve subclinical leaflet thrombosis better than antiplatelet therapy in patients after TAVI?
Subclinical leaflet thrombosis is a common imaging finding after TAVI that may be better prevented and treated with oral anticoagulants than antiplatelet therapy, though its clinical impact remains under investigation.
Transcatheter aortic valve implantation (TAVI) has been considered an important therapy for the treatment of symptomatic severe aortic stenosis. Although the devices and the techniques have been improved some complications may occur and several issues still need to be addressed. The issue of subclinical leaflet thrombosis (SLT) has been recognized as a complication after TAVI, and its incidence ranges from 0% to 40%. Nowadays, computed tomography is considered as the standard method for diagnosis of SLT. The concept of hypoattenuated leaflet thickening (HALT), reduced leaflet motion (RELM), and hypoattenuation affecting motion (HAM) have been used in this topic. Most patients who had SLT were taking single or dual antiplatelet therapy. In addition, these medications were not effective in resolving this complication after TAVI. However, there is a suggestion that oral anticoagulants have a protective and therapeutic effect. With the increasing use of TAVI, it is necessary to have better knowledge about several aspects of this complication, because it may have impact on prognosis. Therefore, some aspects of SLT diagnosis, management, and prognosis are not yet fully understood.
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Oliveira et al. (2020) conducted a review in Subclinical leaflet thrombosis after transcatheter aortic valve implantation. Oral anticoagulants vs. Dual or single antiplatelet therapy was evaluated on Incidence of subclinical leaflet thrombosis (SLT). Subclinical leaflet thrombosis occurs in 0% to 40% of patients after transcatheter aortic valve implantation, and oral anticoagulants appear more effective than antiplatelet therapy for its prevention and treatment.
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