Key result
Aggressive post-TAVR antithrombotic therapy lacks evidence to justify its high bleeding risk.
Why the study?
The optimal antithrombotic regimen after TAVR remains controversial, as concerns about ischemic stroke, valve and subclinical leaflet thrombosis, and long-term durability must be weighed against high bleeding risk and the lack of strong evidence supporting aggressive strategies.
Does a stronger antithrombotic regimen improve thrombotic outcomes without excessively increasing bleeding risk in patients undergoing transcatheter aortic valve replacement?
Does a stronger antithrombotic regimen improve thrombotic outcomes without excessively increasing bleeding risk in patients undergoing transcatheter aortic valve replacement?
This review examines the balance between preventing thrombotic complications (such as stroke and leaflet thrombosis) and mitigating high bleeding risks when selecting optimal antithrombotic regimens for TAVR patients.
Balancing thrombotic and bleeding risks remains central after TAVR; leaves open optimal antithrombotic strategies for randomized trials.
A large amount of evidence supports the widespread use of transcatheter aortic valve replacement (TAVR) among patients who are at low to intermediate risk for surgery. However, several controversies exist about the optimal antithrombotic regimen to use in these patients. On the one hand, concerns about ischemic stroke, subclinical leaflet thrombosis, valve thrombosis, and long-term durability suggest the need for a stronger antithrombotic regimen to ensure a better patient and valve outcome. On the other hand, the high bleeding risk of this population and the current lack of strong evidence in favor of a more aggressive antithrombotic strategy require caution. This review analyzes the rationale of antithrombotic therapy in TAVR illustrating the present scenario and future perspectives.
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Mangieri et al. (2019) conducted a review in Transcatheter aortic valve replacement (TAVR). Antithrombotic therapy after TAVR was evaluated. Antithrombotic therapy after TAVR requires balancing ischemic stroke and leaflet thrombosis risks against high bleeding risk, with a current lack of strong evidence for aggressive strategies.
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