Antithrombotic therapy regimens after transcatheter valve-in-valve and valve-in-ring procedures: a scoping review

Objectives To describe the existing literature on antithrombotic strategies employed after transcatheter valve-in-valve (ViV) and valve-in-ring (ViR) procedures across all valve groups and to provide recommendations for areas of further research. Design We conducted a scoping review reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Data sources We systematically searched CENTRAL, EMBASE and MEDLINE from database inception until 19 January 2026. Reference lists of included studies were also manually screened. Eligibility criteria Randomised-controlled trials, cohort or case-control studies reporting efficacy and/or safety outcomes of antithrombotic therapy in patients undergoing transcatheter ViV or ViR procedures involving aortic, mitral, tricuspid and/or pulmonary valves were included. Data extraction and synthesis Records were screened for eligibility and data were extracted using a structured charting form. Results were synthesised descriptively and grouped according to valve type. Results Of 444 studies screened, 41 were included (10 aortic ViV, 27 mitral ViV/ViR, 1 pulmonary ViV, 1 tricuspid ViV and 2 aortic and mitral ViV). Median sample size was 32 (IQR 14–91; range 5–4243). Ten studies reported a uniform antithrombotic strategy; 30 reported variable strategies, and 1 reported only a protocol-recommended strategy without observed use or adherence. Anticoagulation, with or without antiplatelet therapy, was commonly reported following mitral ViV/ViR, while regimens reported following aortic ViV were highly variable but antiplatelet therapy predominated slightly over anticoagulant therapy. Thrombotic and bleeding outcomes were reported in a highly heterogenous manner. Conclusions Evidence guiding antithrombotic therapy after ViV is heterogeneous and largely observational, underscoring the need for high-quality studies to inform optimal management. Trial registration number This scoping review is registered on the Open Science Framework and can be accessed at: https://osf.io/exvc2/overview?view_only=aeb99d7b79734510826a8ce408e70b03.