Antithrombotic Treatment After Transcatheter Valve Interventions: Current Status and Future Directions

This article appraises the current evidence on this topic.METHODS: This narrative review presents key research findings and guideline recommendations, as well as highlights areas for future research.FINDINGS: After TAVR, randomized trial evidence suggests that single antiplatelet therapy is reasonable for patients without pre-existing indications for oral anticoagulation (OAC). If there is a concurrent indication for OAC, the addition of antiplatelet therapy increases bleeding risk. Whether direct oral anticoagulants achieve better outcomes than vitamin K antagonists is uncertain in this setting. Although OAC has been shown to reduce subclinical leaflet thrombosis (which may progress to structural valve degeneration), bleeding events are unacceptably high. There is a lack of randomized trial data comparing antithrombotic strategies after transcatheter mitral or tricuspid valve replacement or after mitral or tricuspid transcatheter edge-to-edge repair. Single antiplatelet therapy after mitral or tricuspid transcatheter edge-to-edge repair may be appropriate, whereas at least 3 months of OAC is suggested after transcatheter mitral valve replacement or transcatheter tricuspid valve replacement.IMPLICATIONS: Randomized studies are warranted to address the knowledge gaps in antithrombotic therapy after transcatheter valve interventions and to optimize outcomes.PMID:37926630 | DOI:10.1016/j.clinthera.2023.09.028
Source: Clinical Therapeutics - Category: Drugs & Pharmacology Authors: Source Type: research