Antithrombotic treatment in patients undergoing transcatheter aortic valve implantation (TAVI)

Vincent J. Nijenhuis; Naoual Bennaghmouch; Jan-Peter van Kuijk; Davide Capodanno; Jurriën M. ten Berg

doi:10.1160/TH14-10-0821

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2015; 113(04): 674-685
DOI: 10.1160/TH14-10-0821

Review Article

Schattauer GmbH

Antithrombotic treatment in patients undergoing transcatheter aortic valve implantation (TAVI)

Vincent J. Nijenhuis

¹Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands

,

Naoual Bennaghmouch

¹Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands

,

Jan-Peter van Kuijk

¹Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands

,

Davide Capodanno

²Department of Cardiology, University of Catania, Catania, Italy

,

Jurriën M. ten Berg

¹Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands

› Author Affiliations

Abstract

Summary

Transcatheter aortic valve implantation (TAVI) is an established treatment option for symptomatic patients with severe aortic valvular disease who are not suitable for conventional surgical aortic valve replacement. Despite improving experience and techniques, ischaemic and bleeding complications after TAVI remain prevalent and impair survival in this generally old and comorbid-rich population. Due to changing aetiology of complications over time, antiplatelet and anticoagulant therapy after TAVI should be carefully balanced. Empirically, a dual antiplatelet strategy is generally used after TAVI for patients without an indication for oral anticoagulation (OAC; e. g. atrial fibrillation, mechanical mitral valve prosthesis), including aspirin and a thienopyridine. For patients on OAC, a combination of OAC and aspirin or thienopyridine is generally used. This review shows that current registries are unfit to directly compare antithrombotic regimens. Small exploring studies suggest that additional clopidogrel after TAVI only affects bleeding and not ischemic complications. However, these studies are lack in quality in terms of Cochrane criteria. Currently, three randomised controlled trials are recruiting to gather more knowledge about the effects of clopidogrel after TAVI.

Keywords

Transcatheter aortic valve implantation (TAVI) - antithrombotic - antiplatelet - anticoagulation - bleeding - stroke - clopidogrel

Full Text

References

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