Early Leaflet Thrombosis After TAVR
What are the medium-term outcomes for patients with leaflet thrombosis following transcatheter aortic valve replacement (TAVR)?
The authors performed a single-center observational study of patients diagnosed with leaflet thrombosis shortly after TAVR implantation (median 5 days) between May 2012 and June 2017. All patients undergoing TAVR were treated with aspirin or aspirin plus clopidogrel postoperatively for 6 months followed by lifelong low-dose aspirin. Between May 2012 and May 2015, all patients with confirmed leaflet thrombosis were treated with anticoagulation plus clopidogrel for 3 months (or until thrombosis resolved). After May 2015, patients with leaflet thrombosis were treated with dual antiplatelet therapy unless they had a separate indication for anticoagulation.
Leaflet thrombosis occurred in 120/754 (15.9%) TAVR patients. These patients were more commonly women and less often had atrial fibrillation. During a median follow-up of 406 days, there were no differences in all-cause mortality (13.4% vs. 14.6%, p = 0.912) or the combined secondary endpoint of stroke and transient ischemic attack (1.5% vs. 3.2%, p = 0.331).
The authors concluded that patients undergoing TAVR who develop leaflet thrombosis are not at increased risk of all-cause mortality or stroke.
This observational study suggests that a finding of leaflet thrombosis did not portend an increased risk of all-cause mortality or stroke. However, this finding should be tempered by the observational design of the study and the change in anticoagulation practice part way through the study. It remains to be determined how best to treat patients with TAVR leaflet thrombosis, specifically if a short course of anticoagulation is necessary. Ongoing studies (ATLANTIS and POPular-TAVR) may provide more information.
Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Anticoagulation Management and Atrial Fibrillation, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and VHD, Interventions and Structural Heart Disease
Keywords: Anticoagulants, Atrial Fibrillation, Heart Valve Diseases, Heart Valve Prosthesis, Ischemic Attack, Transient, Platelet Aggregation Inhibitors, Stroke, Thrombosis, Transcatheter Aortic Valve Replacement, Vascular Diseases
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