Dual Anti-platelet Therapy After Transcatheter Aortic Valve Implantation: Double Trouble?

Excerpt

Transcatheter aortic valve implantation (TAVI) has emerged over the last decade as a viable treatment option for patients with severe symptomatic aortic stenosis (AS) across all risk strata with TAVI procedural volumes increasing significantly over time and currently exceeding surgical aortic valve replacement surgery volumes in the USA [1]. The most common complication associated with TAVI is vascular bleeding, which portends a higher mortality risk [2]. Bleeding risk is related to a combination of patient-related factors and pharmacotherapies. Therefore, it is increasingly important to choose, in a shared-decision making process with the patient, the appropriate antithrombotic therapy post-TAVI that will balance bleeding risk with thromboembolic events and long-term valve function to give the best outcomes for patients. This is an important area of consideration as subclinical leaflet thrombosis appears to be more common after TAVI than surgical valve replacement (up to 10–15% in some series) and is associated with increased risk of cerebrovascular events [3, 4]. …