title: Antithrombotic treatment in patients undergoing transcatheter aortic valve implantation (TAVI).
abstract: 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.
authors: Vincent J
authors: VJ
authors: Nijenhuis
authors: Naoual
authors: N
authors: Bennaghmouch
authors: Jan-Peter
authors: JP
authors: van Kuijk
authors: Davide
authors: D
authors: Capodanno
authors: Jurriën ten Berg, MD, PhD, FESC, FACC, Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands, Tel.: +31 30 6099111, Fax: +31 30 6092274, E-mail: j.ten.berg@antoniusziekenhuis.nl.
authors: Jurriën M
authors: JM
authors: ten Berg
mesh_terms: D000284:Administration, Oral; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage; D001021:Aortic Valve / Q000503:physiopathology; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D015897:Comorbidity; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D012042:Registries; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors
keywords: Transcatheter aortic valve implantation (TAVI); anticoagulation; antiplatelet; antithrombotic; bleeding; clopidogrel; stroke