Novel Perspective for Antithrombotic Therapy in TAVI

Curr Pharm Des. 2020;26(23):2789-2803. doi: 10.2174/1381612826666200413083746.

Abstract

While surgical aortic valve replacement (SAVR) was for years the only available treatment for symptomatic aortic stenosis, the introduction of transcatheter aortic valve implantation (TAVI) in 2002 and the improvement of its technical aspects in the following years, has holistically changed the synchronous therapeutic approach of aortic valve stenosis. Recent evidence has expanded the indication of TAVI from high to lower surgical risk populations with symptomatic aortic stenosis. The administration of antithrombotic therapy periprocedurally and its maintenance after a successful TAVI is crucial for the prevention of complications and affects postprocedural survival. Randomized controlled trials investigating the appropriate combination and the duration of antithrombotic treatment after TAVI are for the moment scarce. This review article sheds light on the underlying pathogenetic mechanisms contributing in periprocedural TAVI thrombotic complications and discuss the efficacy of current antithrombotic policies as evaluated in randomized trials.

Keywords: DAPT; NOAC; SAVR; TAVI; VKA; antithrombotic therapy.

Publication types

  • Review

MeSH terms

  • Aortic Valve / surgery
  • Aortic Valve Stenosis* / drug therapy
  • Aortic Valve Stenosis* / surgery
  • Fibrinolytic Agents / therapeutic use
  • Heart Valve Prosthesis Implantation*
  • Heart Valve Prosthesis*
  • Humans
  • Risk Factors
  • Transcatheter Aortic Valve Replacement*
  • Treatment Outcome

Substances

  • Fibrinolytic Agents