The following are key points to remember from this review article on adjunctive antithrombotic therapy for patients with aortic stenosis undergoing TAVR:

1. Transcatheter aortic valve replacement (TAVR) has become the preferred strategy for treating severe aortic stenosis. However, no single antithrombotic regimen is recommended in the guidelines. Treatment approaches vary significantly.
2. Stroke remains a significant complication of TAVR, especially in high-risk patients who experienced a near two-fold higher rate of stroke as compared to surgical valve replacement. Roughly 50% of strokes occurred within the first 30 days after TAVR.
3. Bleeding after TAVR indicates an adverse prognosis. Nearly 80% of all bleeding events occur within the first 30 days following TAVR.
4. Risk factors for stroke and bleeding event differ based on the timing since TAVR. Procedural risk factors (e.g., balloon post-dilation, valve migration, transapical approach, large sheath diameter) are key in the initial time period. Atrial fibrillation is associated with both stroke and bleeding events following TAVR.
5. In patients with an indication for anticoagulation therapy, aspirin or clopidogrel monotherapy only (no anticoagulation) is recommended in the periprocedural period. In the first 3-6 months postprocedure, anticoagulation therapy with or without single antiplatelet therapy is recommended, depending on the risk of bleeding. After the initial 3- to 6-month postprocedure period, then oral anticoagulation monotherapy is recommended.
6. In patients without an indication for anticoagulation therapy, aspirin or clopidogrel monotherapy is recommended in the periprocedural period. Then, for the first 3-6 months, either single or dual antiplatelet therapy is recommended, based on bleeding risk. After the initial 3-6 months, single antiplatelet therapy is recommended long-term.
7. If a patient develops new-onset atrial fibrillation or subclinical leaflet thrombosis while on antiplatelet therapy, initiation of anticoagulation is recommended.
8. Multiple ongoing studies are comparing various combinations of antithrombotic therapy. Many of these studies are testing less aggressive antithrombotic regimens aimed at reducing the risk of postprocedure bleeding. Others are studying the use of direct oral anticoagulant therapy, especially in patients with atrial fibrillation undergoing TAVR.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Prevention, Valvular Heart Disease, Anticoagulation Management and Atrial Fibrillation, Atrial Fibrillation/Supraventricular Arrhythmias, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and VHD, Interventions and Structural Heart Disease

Keywords: Anticoagulants, Aortic Valve Stenosis, Aspirin, Atrial Fibrillation, Cardiac Surgical Procedures, Dilatation, Fibrinolytic Agents, Heart Valve Diseases, Hemorrhage, Platelet Aggregation Inhibitors, Risk Factors, Secondary Prevention, Stroke, Thrombosis, Transcatheter Aortic Valve Replacement, Vascular Diseases


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