Antithrombotic therapy after transcatheter aortic valve implantation

Evidence to guide choice of antithrombotic therapy after transcatheter aortic valve implantation (TAVI) is lacking consensusGreco, 2020.

Following TAVI, single antiplatelet therapy is reasonable, particularly in patients already taking an anticoagulant drug or who have other risk factors for bleeding (eg a history of gastrointestinal tract bleeding)Mahalwar, 2022.

Dual antiplatelet therapy (DAPT) with low-dose aspirin and a P2Y₁₂ inhibitor (clopidogrel, prasugrel or ticagrelor) is also a reasonable approach following TAVI. DAPT is commonly prescribed for 3 to 6 months and is followed by lifelong monotherapy with either low-dose aspirin or a P2Y₁₂ inhibitor. There is evidence to suggest that a P2Y₁₂ inhibitor is preferable to aspirin for lifelong monotherapy.

Unless there is a separate indication for oral anticoagulation, it is not recommended because of the increased bleeding risk with no therapeutic advantageVahanian, 2021Writing Committee, 2021. Evidence suggests there is an increased risk of leaflet thrombosis following TAVI. Oral anticoagulation appears to resolve leaflet thrombosis and restore normal leaflet motion; however, at the time of writing, oral anticoagulant therapy is not routinely used after TAVI.