The Use of Antiplatelet and Anticoagulation After TAVR: A Brief Review of Important Literature

Abstract

Aortic stenosis is the most common valvular heart disease in the elderly patient population.  Surgical aortic valve replacement (SAVR) has been the standard of practice for treating aortic stenosis for years.  But recently in the past decade, the minimally invasive procedure Transcatheter aortic valve replacement/implantation (TAVR/TAVI) has been a revolutionary treatment modality for aortic stenosis patients, particularly those who are at high risk of surgery.  The patients who undergo TAVR are at high risk for bleeding and thromboembolic events afterward. The use of antiplatelet and anticoagulation after TAVR is to decrease the risk of thromboembolic complications such as stroke, but it comes with the risk of bleeding associated with antiplatelet and antithrombotic.  Current guidelines recommend the use of dual antiplatelet (DAPT) for 3 to 6-month after TAVR in the absence of an indication for oral anticoagulation followed by lifelong single antiplatelet therapy (SAPT).  However, the use of dual antiplatelet is associated with an increased risk of bleeding without significant ischemic benefits.  Lifelong oral anticoagulation is recommended for patients who have other indications for anticoagulation.  These treatment guidelines are driven by expert opinion, given the lack of large randomized control trials (RCT).  In this review, we aim to discuss the need for antithrombotic and antiplatelets after TAVR and review important literature about current practice and expert recommendations about antiplatelet and anticoagulation after TAVR.