title: Adjuvant Antithrombotic Therapy in TAVR.
abstract: Transcatheter aortic valve replacement (TAVR) has developed into an important alternative to surgical aortic valve replacement (SAVR) for patients with severe aortic stenosis (AS). Adjuvant antithrombotic therapies are commonly used during and after TAVR to decrease the risk of valve thrombosis and thromboembolic cerebrovascular events (CVEs) but consequently increase the risk of bleeding. This article reviews the past and current clinical data regarding adjuvant antithrombotic therapies in TAVR.
  
  
  
  Cerebrovascular and bleeding events during and after TAVR are associated with substantial morbidity and mortality. Bivalirudin, a direct thrombin inhibitor, has been shown to be safe alternative to unfractionated heparin (UFH) as procedural anticoagulation during TAVR; however, sparse evidence exists to guide use of antiplatelet and anticoagulant therapies in patients after TAVR. Multiple studies comparing different antithrombotic regimens in the post-TAVR setting are currently underway. Current guidelines recommend intra-procedural anticoagulation with UFH for during TAVR and with dual antiplatelet therapy (DAPT) after TAVR. There is a need to better understand the role of adjuvant antithrombotic therapies in TAVR. The results of ongoing studies are needed to develop evidence-based guidance for the use of adjuvant antithrombotic therapies after TAVR.
authors.affiliation: Falk Cardiovascular Research Center, Stanford University School of Medicine, 870 Quarry Road, Stanford, CA, 94305, USA. romalley@stanford.edu.
authors.forename: Ryan G
authors.initials: RG
authors.lastname: O'Malley
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, Stanford Center for Clinical Research, Stanford University School of Medicine, 300 Pasteur Drive, Grant S102, Stanford, CA, 94305, USA.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Mahaffey
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Room A260 MC:5319, Stanford, CA, 94305, USA.
authors.forename: William F
authors.initials: WF
authors.lastname: Fearon
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D001024:Aortic Valve Stenosis / Q000188:drug therapy* / Q000601:surgery*; D017024:Chemotherapy, Adjuvant / Q000379:methods*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D019990:Perioperative Care / Q000379:methods*; D017410:Practice Guidelines as Topic; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents
keywords: Anticoagulant; Antiplatelet; Aortic stenosis (AS); Bleeding; Stroke; Transcatheter aortic valve replacement (TAVR)