Antithrombotic Therapy in Patients Undergoing Transcatheter Aortic Valve Implantation

This review provides a comprehensive overview of the available data on antithrombotic therapy after transcatheter aortic valve replacement.

Antiplatelet therapy (APT) is favored over the use of a vitamin K antagonist (VKA) due to the lower risk of major bleeding associated with APT. Single APT is preferred over dual APT, but dual APT may be required for patients who had an acute coronary syndrome in the previous 6 months, who have complex coronary stenting, who have large aortic arch atheromas, or who had suffered a previous noncardioembolic stroke. VKA monotherapy may be needed for patients with atrial fibrillation or other indications for long-term oral anticoagulation.

Antithrombotic therapy should be selected according to the early device-related risks and the patient’s underlying thrombotic risk. APT should be selected as the primary treatment over VKA unless other indications for VKA are present.