Does a rivaroxaban-based antithrombotic strategy prevent subclinical leaflet-motion abnormalities compared to an antiplatelet-based strategy in patients without an indication for long-term anticoagulation who have undergone successful TAVR?
While a rivaroxaban-based strategy reduces subclinical leaflet-motion abnormalities after TAVR, it is associated with higher risks of death, thromboembolic complications, and bleeding compared to an antiplatelet-based strategy.
In a substudy of a trial involving patients without an indication for long-term anticoagulation who had undergone successful TAVR, a rivaroxaban-based antithrombotic strategy was more effective than an antiplatelet-based strategy in preventing subclinical leaflet-motion abnormalities. However, in the main trial, the rivaroxaban-based strategy was associated with a higher risk of death or thromboembolic complications and a higher risk of bleeding than the antiplatelet-based strategy. (Funded by Bayer; GALILEO-4D ClinicalTrials.gov number, NCT02833948.).
Backer et al. (Sat,) studied this question.