What is the clinical evidence from this study?

Study design: Case Report. Population: Bioprosthetic valve thrombosis after TAVR (n=1). Intervention: Warfarin. Primary outcome: Symptomatic and hemodynamic resolution.

What does this research mean for the field?

Therapeutic anticoagulation can achieve complete symptomatic and hemodynamic resolution in severe obstructive pan-leaflet bioprosthetic thrombosis after transcatheter aortic valve replacement. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To describe the presentation, multimodality diagnostic imaging, and medical management of severe obstructive pan-leaflet bioprosthetic valve thrombosis following transcatheter aortic valve replacement.

October 3, 2026JACC Case ReportsOpen Access

Severe Obstructive Pan-Leaflet Thrombosis After Transcatheter Aortic Valve Replacement

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Key result

Warfarin achieves complete resolution of severe obstructive post-TAVR leaflet thrombosis by ~3 months.

Why the study?

Bioprosthetic valve thrombosis is an uncommon but important cause of late valve dysfunction after TAVR, with complex anticoagulant management after sequential procedures.

Does warfarin improve symptoms and hemodynamics in a patient with severe obstructive pan-leaflet thrombosis after TAVR?

Key Points

To describe the presentation, multimodality diagnostic imaging, and medical management of severe obstructive pan-leaflet bioprosthetic valve thrombosis following transcatheter aortic valve replacement.
Evaluated an 82-year-old man presenting with exertional dyspnea and orthostasis after transcatheter aortic valve replacement, left atrial appendage occlusion, and oral anticoagulation discontinuation.
Performed transthoracic echocardiography and multidetector computed tomography to evaluate leaflet excursion, valve morphology, and transvalvular hemodynamics.
Initiated oral anticoagulation with warfarin and reassessed symptomatic status and valve hemodynamics at 3 months.
Imaging revealed severe thrombosis across all three bioprosthetic leaflets with restricted leaflet motion and marked transvalvular gradient elevation.
Therapeutic anticoagulation with warfarin produced complete symptomatic relief and hemodynamic normalization with fully restored leaflet motion at 3-month follow-up.

Study Design

Type

Case Report (n=1)

Structured PICO

Does warfarin improve symptoms and hemodynamics in a patient with severe obstructive pan-leaflet thrombosis after TAVR?

Population

An 82-year-old man with a history of TAVR who developed severe obstructive pan-leaflet thrombosis after left atrial appendage occlusion and discontinuation of oral anticoagulation.

Intervention

Warfarin

Outcome

Symptomatic and hemodynamic resolution

Therapeutic anticoagulation with warfarin can successfully restore leaflet motion and hemodynamics in patients presenting with severe obstructive pan-leaflet thrombosis after TAVR.

Implication

Alerts to thrombosis risk after anticoagulation cessation post-TAVR; hypothesis-generating and should not yet change practice.

Abstract

BACKGROUND: Bioprosthetic valve thrombosis is an uncommon but important cause of late bioprosthetic valve dysfunction after transcatheter aortic valve replacement (TAVR). CASE SUMMARY: An 82-year-old man with a history of TAVR presented with worsening exertional dyspnea and orthostasis after recent left atrial appendage occlusion and discontinuation of oral anticoagulation. Echocardiography demonstrated a marked rise in transvalvular gradients with restricted leaflet motion, and computed tomography confirmed severe thrombosis of all 3 bioprosthetic leaflets. Warfarin was initiated, resulting in complete symptomatic and hemodynamic resolution at 3 months. DISCUSSION: This case highlights the complexity of anticoagulant and antithrombotic management after sequential TAVR and left atrial appendage occlusion and the value of multimodality imaging in diagnosing obstructive transcatheter valve thrombosis. TAKE-HOME MESSAGES: New symptoms or unexplained rise in transvalvular gradients after TAVR should prompt urgent evaluation for leaflet thrombosis. Therapeutic anticoagulation can restore leaflet motion and hemodynamics.

Discussion

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Cite This Study

Ang et al. (2026) conducted a case report in Bioprosthetic valve thrombosis after TAVR (n=1). Warfarin was evaluated on Symptomatic and hemodynamic resolution. Initiation of warfarin for severe obstructive pan-leaflet thrombosis after TAVR resulted in complete symptomatic and hemodynamic resolution at 3 months.

synapsesocial.com/papers/6ac09e241652f928be5469d2 https://doi.org/10.1016/j.jaccas.2026.110417

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Implication

Alerts to thrombosis risk after anticoagulation cessation post-TAVR; hypothesis-generating and should not yet change practice.

Severe Obstructive Pan-Leaflet Thrombosis After Transcatheter Aortic Valve Replacement

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Severe Obstructive Pan-Leaflet Thrombosis After Transcatheter Aortic Valve Replacement

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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