Antithrombotic therapy after transcatheter mitral valve repair

Vahanian, 2021 Writing Committee, 2021

Patients receiving transcatheter mitral valve repair (TMVR) for regurgitation (eg MitraClips or PASCAL devices) are commonly already in atrial fibrillation, so are taking or require oral anticoagulation. Anticoagulant therapy is normally continued after the mitral valve repair. Aspirin is sometimes added for 1 to 3 months in these patients.

For patients not previously requiring oral anticoagulation, there are no evidence-based guidelines for antithrombotic therapy after TMVR. Dual antiplatelet therapy (DAPT) for 1 to 3 months is commonly used, sometimes followed by single antiplatelet therapy indefinitely. One trial suggested that initial anticoagulation with warfarin for 1 month followed by DAPT might reduce the incidence of stroke at 30 days in patients not otherwise needing ongoing anticoagulation¹Geis, 2020.

¹ Geis N, Raake P, Kiriakou C, Mereles D, Frankenstein L, Abu-Sharar H, et al. Temporary oral anticoagulation after MitraClip - a strategy to lower the incidence of post-procedural stroke? Acta Cardiol 2020;75(1):61-7. URL Return