Antithrombotic Therapy Following Transcatheter Aortic Valve Replacement
Due to a large technical improvement in the past decade, transcatheter aortic valve replacement (TAVR) has expanded to lower-surgical-risk patients with symptomatic and severe aortic stenosis. While mortality rates related to TAVR are decreasing, the prognosis of patients is still impacted by ischem...
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| Format: | Article |
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MDPI AG
2022-04-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/8/2190 |
| _version_ | 1797410659882762240 |
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| author | Camille Granger Paul Guedeney Jean-Philippe Collet |
| author_facet | Camille Granger Paul Guedeney Jean-Philippe Collet |
| author_sort | Camille Granger |
| collection | DOAJ |
| description | Due to a large technical improvement in the past decade, transcatheter aortic valve replacement (TAVR) has expanded to lower-surgical-risk patients with symptomatic and severe aortic stenosis. While mortality rates related to TAVR are decreasing, the prognosis of patients is still impacted by ischemic and bleeding complications, and defining the optimal antithrombotic regimen remains a priority. Recent randomized control trials reported lower bleeding rates with an equivalent risk in ischemic outcomes with single antiplatelet therapy (SAPT) when compared to dual antiplatelet therapy (DAPT) in patients without an underlying indication for anticoagulation. In patients requiring lifelong oral anticoagulation (OAC), the association of OAC plus antiplatelet therapy leads to a higher risk of bleeding events with no advantages on mortality or ischemic outcomes. Considering these data, guidelines have recently been updated and now recommend SAPT and OAC alone for TAVR patients without and with a long-term indication for anticoagulation. Whether a direct oral anticoagulant or vitamin K antagonist provides better outcomes in patients in need of anticoagulation remains uncertain, as recent trials showed a similar impact on ischemic and bleeding outcomes with apixaban but higher gastrointestinal bleeding with edoxaban. This review aims to summarize the most recently published data in the field, as well as describe unresolved issues. |
| first_indexed | 2024-03-09T04:33:24Z |
| format | Article |
| id | doaj.art-de672e2ac99f4b288a4715a2df8e8751 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T04:33:24Z |
| publishDate | 2022-04-01 |
| publisher | MDPI AG |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-de672e2ac99f4b288a4715a2df8e87512023-12-03T13:32:54ZengMDPI AGJournal of Clinical Medicine2077-03832022-04-01118219010.3390/jcm11082190Antithrombotic Therapy Following Transcatheter Aortic Valve ReplacementCamille Granger0Paul Guedeney1Jean-Philippe Collet2ACTION Study Group, UMR_S 1166, Institut de Cardiologie, Sorbonne Université, Pitié Salpêtrière Hospital (APHP), 75013 Paris, FranceACTION Study Group, UMR_S 1166, Institut de Cardiologie, Sorbonne Université, Pitié Salpêtrière Hospital (APHP), 75013 Paris, FranceACTION Study Group, UMR_S 1166, Institut de Cardiologie, Sorbonne Université, Pitié Salpêtrière Hospital (APHP), 75013 Paris, FranceDue to a large technical improvement in the past decade, transcatheter aortic valve replacement (TAVR) has expanded to lower-surgical-risk patients with symptomatic and severe aortic stenosis. While mortality rates related to TAVR are decreasing, the prognosis of patients is still impacted by ischemic and bleeding complications, and defining the optimal antithrombotic regimen remains a priority. Recent randomized control trials reported lower bleeding rates with an equivalent risk in ischemic outcomes with single antiplatelet therapy (SAPT) when compared to dual antiplatelet therapy (DAPT) in patients without an underlying indication for anticoagulation. In patients requiring lifelong oral anticoagulation (OAC), the association of OAC plus antiplatelet therapy leads to a higher risk of bleeding events with no advantages on mortality or ischemic outcomes. Considering these data, guidelines have recently been updated and now recommend SAPT and OAC alone for TAVR patients without and with a long-term indication for anticoagulation. Whether a direct oral anticoagulant or vitamin K antagonist provides better outcomes in patients in need of anticoagulation remains uncertain, as recent trials showed a similar impact on ischemic and bleeding outcomes with apixaban but higher gastrointestinal bleeding with edoxaban. This review aims to summarize the most recently published data in the field, as well as describe unresolved issues.https://www.mdpi.com/2077-0383/11/8/2190TAVRantithrombotic therapyoral anticoagulationDOACVKASAPT |
| spellingShingle | Camille Granger Paul Guedeney Jean-Philippe Collet Antithrombotic Therapy Following Transcatheter Aortic Valve Replacement Journal of Clinical Medicine TAVR antithrombotic therapy oral anticoagulation DOAC VKA SAPT |
| title | Antithrombotic Therapy Following Transcatheter Aortic Valve Replacement |
| title_full | Antithrombotic Therapy Following Transcatheter Aortic Valve Replacement |
| title_fullStr | Antithrombotic Therapy Following Transcatheter Aortic Valve Replacement |
| title_full_unstemmed | Antithrombotic Therapy Following Transcatheter Aortic Valve Replacement |
| title_short | Antithrombotic Therapy Following Transcatheter Aortic Valve Replacement |
| title_sort | antithrombotic therapy following transcatheter aortic valve replacement |
| topic | TAVR antithrombotic therapy oral anticoagulation DOAC VKA SAPT |
| url | https://www.mdpi.com/2077-0383/11/8/2190 |
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