Antithrombotic therapy after transcatheter aortic valve implantation.

ABSTRACT

INTRODUCTION: Transcatheter aortic valve implantation (TAVI) is a treatment option for patients with symptomatic severe aortic stenosis across the entire spectrum of surgical risk. TAVI conveys some risk for thrombotic complications, requiring antithrombotic drugs for their prevention. Bleeding events represent the major drawback of antithrombotic therapy, which should be carefully tailored over the individual patient's risk profile. AREAS COVERED This review aimed at exploring the rationale for the adoption of a tailored antithrombotic therapy after successful TAVI, with a description and analysis of common complications and their impact on therapy selection. In addition, we aimed at reviewing and discussing current knowledge in this area, with a main focus on the high-quality evidence supporting latest guideline recommendations. Finally, ongoing studies and future directions on antithrombotic therapy after TAVI were outlined. EXPERT OPINION Initial experience with antithrombotic therapy after TAVI was derived from percutaneous coronary intervention practice. Accruing evidence in the field led to the current monotherapy paradigm, which prioritizes oral anticoagulant and single antiplatelet therapy in patients with or without an established indication for long-term anticoagulation, respectively. Future studies will investigate the role of alternative antithrombotic strategies to improve clinical outcomes of TAVI patients by minimizing both thrombotic and bleeding complications.

Aortic stenosis is the most common primary valve disease requiring treatment. Transcatheter aortic valve implantation (TAVI) is a percutaneous treatment option for patients with symptomatic severe aortic stenosis across the entire spectrum of surgical risk. To prevent several complications of TAVI, antithrombotic drugs (i.e. antiplatelets or anticoagulants) are required after the intervention. The major drawback of such therapies is represented by bleeding, which makes important a careful consideration of the individual patient's risk profile. This review article explores the rationale for the adoption of a tailored antithrombotic therapy after TAVI, with a description and analysis of common complications and their impact on therapy selection. In addition, we reviewed and discussed current knowledge in this area, with a main focus on the evidence supporting latest guideline recommendations and their potential evolution. Finally, ongoing studies and future directions on antithrombotic therapy after TAVI were presented.