Antithrombotic treatment in patients undergoing transcatheter aortic valve replacement

Since 2008, the role of transcatheter aortic valve replacement (TAVR) has become a guidelines-based alternative for surgical aortic valve replacement in inoperable and high-risk patients. Adjunctive pharmacological therapy, primarily with heparin during the procedure and dual antiplatelet therapy with aspirin and clopidogrel for at least 1-6 months following implantation, has been considered the standard of care in clinical TAVR trials. However, the rationale for these regimens was extrapolated from data regarding stenting in percutaneous coronary intervention (PCI), the treatment for patients with bioprosthetic surgical valve replacement, and small observational studies of TAVR. Moreover, pharmacological recommendations vary with both the type and site of the valve and the presence or absence of underlying risk factors for thrombus formation. The purpose of this chapter is to review the data regarding the optimal antithrombotic regimen in TAVR recipients, including patients with coronary artery disease post-PCI, and in patients with concomitant atrial fibrillation requiring anticoagulant therapy in conjugation with their antiplatelet therapy.