Author + information
- Received July 22, 2019
- Revision received August 26, 2019
- Accepted August 27, 2019
- Published online October 14, 2019.
- Antonio Mangieri, MDa,∗∗ (, )@AntonioMangieri,
- Claudio Montalto, MDb,∗,
- Enrico Poletti, MDc,
- Alessandro Sticchi, MDd,
- Gabriele Crimi, MDb,
- Francesco Giannini, MDa,
- Azeem Latib, MDe,
- Davide Capodanno, MDf and
- Antonio Colombo, MDa
- aInterventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
- bDivision of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- cInterventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
- dUnit of Cardiovascular Science, Campus Bio-Medico University, Rome, Italy
- eDivision of Cardiology, Department of Medicine, University of Cape Town, Cape Town Department of Cardiology, Montefiore Medical Center, New York, New York
- fDivision of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
- ↵∗Address for correspondence:
Dr. Antonio Mangieri, Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Via Madonna di Genova, 1, 48033 Cotignola, Ravenna, Italy.
• TAVR is associated with bleeding complications and short- and long-term thrombotic risk.
• Clinical and bioengineering aspects of TAVR should be assessed for optimal medical management, but evidence is still scarce and scattered.
• Data about optimal antithrombotic therapy are still uncertain, without clear proof of advantage of stronger antithrombotic regimen to avoid valve degeneration.
• Research should seek to clarify the best strategy for different patient subsets.
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.
- aortic stenosis
- direct oral anticoagulants
- transcatheter aortic valve replacement
↵∗ Drs. Mangieri and Montalto contributed equally to this work.
Dr. Latib has served on the Advisory Board of Medtronic and Abbott; and has served as a consultant for Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 22, 2019.
- Revision received August 26, 2019.
- Accepted August 27, 2019.
- 2019 American College of Cardiology Foundation
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