title: Balancing the Risks of Thrombosis and Bleeding Following Transcatheter Aortic Valve Implantation: Current State-of-Evidence.
abstract: While transcatheter aortic valve implantation (TAVI) has rapidly evolved as an acceptable alternative to conventional surgical aortic valve replacement in elderly, high-risk surgical candidates with critical aortic stenosis, thrombotic and bleeding complications remain relatively frequent and potentially life-threatening. Thrombotic events during and following TAVI relate to the dynamic interplay between the systemic burden of atherosclerotic disease, atrial arrhythmias, device and native aortic valve interactions, as well as platelet and coagulation cascade activation. Bleeding in the acute setting relates primarily to access site vascular complications, but also appears related to pre-existing renal impairment and anemia. Current pre-, peri- and post-procedural anti-thrombotic regimens are empirical, based on expert consensus following extrapolation from the wealth of experience gleaned following percutaneous coronary intervention. However the complexities of the TAVI procedure, the high-risk clinical substrate and competing effects of anti-thrombotic regimens and bleeding risk are yet to be prospectively assessed in randomized clinical trials for defining evidence-based anti-thrombotic strategies.
authors.forename: Rishi
authors.initials: R
authors.lastname: Puri
authors.forename: Omar Abdul-Jawad
authors.initials: OA
authors.lastname: Altisent
authors.forename: Francisco
authors.initials: F
authors.lastname: Campelo-Parada
authors.forename: Maria
authors.initials: M
authors.lastname: del Trigo
authors.forename: Ander
authors.initials: A
authors.lastname: Regueiro
authors.affiliation: Quebec Heart & Lung Institute, Laval University 2725 chemin Ste-Foy Quebec City, Quebec, Canada (G1V 4G5). josep.rodes@criucpq.ulaval.ca.
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
mesh_terms: D006470:Hemorrhage / Q000150:complications / Q000209:etiology*; D006801:Humans; D018570:Risk Assessment; D013927:Thrombosis / Q000150:complications / Q000209:etiology*; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*