Apixaban and Valve Thrombosis After Transcatheter Aortic Valve Replacement

Montalescot, Gilles; Redheuil, Alban; Vincent, Flavien; Desch, Steffen; Benedictis, Mauro De; Eltchaninoff, Hélène; Trenk, Dietmar; Serfaty, Jean-Michel; Charpentier, Etienne; Bouazizi, Khaoula; Prigent, Mikael; Guedeney, Paul; Salloum, Tomy; Berti, Sérgio; Cequier, Ángel; Lefèvre, Thierry; Leprince, Pascal; Silvain, Johanne; Belle, Éric Van; Neumann, Franz Josef; Portal, Jean-Jacques; Vicaut, Éric; Collet, Jean‐Philippe

doi:10.1016/j.jcin.2022.07.014

Cited by 40 publications

(24 citation statements)

References 20 publications

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“…Management options include anticoagulation, surgery, or thrombolysis [ 52 ]. Asymptomatic valve thrombosis/HALT was not found to be associated with mortality or stroke at 3 years after TAVI, and therefore does not require specific treatment according to current recommendations [ 53 , 54 ]. There is limited data to inform management of bioprosthetic valvular thrombosis, although a prospective study in patients with suspected thrombosis treated with warfarin demonstrated reduction in valve gradient [ 55 ].…”

Section: Etiology For Post Avr Heart Failurementioning

confidence: 99%

Heart failure and excess mortality after aortic valve replacement in aortic stenosis

Aziminia

Nitsche

Mravljak

et al. 2023

Expert Review of Cardiovascular Therapy

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Introduction In aortic stenosis (AS), the heart transitions from adaptive compensation to an AS cardiomyopathy and eventually leads to decompensation with heart failure. Better understanding of the underpinning pathophysiological mechanisms is required in order to inform strategies to prevent decompensation. Areas covered In this review, we therefore aim to appraise the current pathophysiological understanding of adaptive and maladaptive processes in AS, appraise potential avenues of adjunctive therapy before or after AVR and highlight areas of further research in the management of heart failure post AVR. Expert opinion Tailored strategies for the timing of intervention accounting for individual patient’s response to the afterload insult are underway, and promise to guide better management in the future. Further clinical trials of adjunctive pharmacological and device therapy to either cardioprotect prior to intervention or promote reverse remodeling and recovery after intervention are needed to mitigate the risk of heart failure and excess mortality.

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Section: Etiology For Post Avr Heart Failurementioning

confidence: 99%

Heart failure and excess mortality after aortic valve replacement in aortic stenosis

Aziminia

Nitsche

Mravljak

et al. 2023

Expert Review of Cardiovascular Therapy

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“…The ATLANTIS-4D CT substudy examined the effect of apixaban on leaflet thrombosis at 3 to 6 months (Table ). 36 The primary end point was the proportion of patients with at least 1 leaflet with RLM of grade 3 to 4 (moderately restricted or worse) or HALT grade 3 to 4. Interpretable imaging was available for 370 patients randomly assigned to apixaban and 392 patients randomly assigned to standard of care.…”

Section: Randomized Trials Of Oac After Tavrmentioning

confidence: 99%

Subclinical Leaflet Thrombosis and Anticoagulation After Transcatheter Aortic Valve Replacement

et al. 2022

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IMPORTANCE Subclinical leaflet thrombosis affects approximately 15% of patients after transcatheter aortic valve replacement (TAVR). The pathophysiology and clinical significance of leaflet thrombosis remain incompletely understood. Defining the optimal management strategy in patients who are asymptomatic, including the role for oral anticoagulation (OAC), is a key challenge for the field.OBSERVATIONS Three recent randomized trials have evaluated the role of OAC in patients after TAVR. These studies have confirmed prior observational data suggesting that OAC is effective at prevention of subclinical leaflet thrombosis. Overall, however, OAC does not lead to a clinical benefit over the period studied, and in some patients may be harmful owing to bleeding risk. CONCLUSIONS AND RELEVANCEStrategies for identification of patients in whom the benefit of OAC outweighs the risks are required for optimization of long-term outcome after TAVR. This requires clearer insights into the mechanisms of asymptomatic leaflet thrombosis, its clinical significance, and patient-specific risks of bleeding and structural valve degeneration.

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“…8,9 Several trials have explored a variety of anti-thrombotic regimens in the post-TAVI population, yet fail to provide conclusive evidence on the optimal treatment strategy in patients with and without a long-term indication for OACs. [10][11][12][13][14][15][16][17] Furthermore, data from the ATLANTIS and ENVISAGE-TAVI AF trials expand the available evidence base beyond that incorporated into recent ESC guidelines and consensus recommendations. 4,7,11,14,16,17 This on-going clinical debate and new data reinforce the need for updates to existing guidelines.…”

mentioning

confidence: 99%

“…[10][11][12][13][14][15][16][17] Furthermore, data from the ATLANTIS and ENVISAGE-TAVI AF trials expand the available evidence base beyond that incorporated into recent ESC guidelines and consensus recommendations. 4,7,11,14,16,17 This on-going clinical debate and new data reinforce the need for updates to existing guidelines.…”

mentioning

confidence: 99%

“…Our goal was to formulate consensus statements from practising clinicians with reference to currently available data (in particular, the recent ATLANTIS and ENVISAGE-TAVI AF trials). 11,14,16,17 We also provide an overview of remaining evidence gaps and concise evidence summaries from the aforementioned trials with the intention of informing decision-making and optimising patient outcomes following TAVI.…”

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confidence: 99%

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An Update on Anti-thrombotic Therapy Following Transcatheter Aortic Valve Implantation: Expert Cardiologist Opinion from a UK and Ireland Delphi Group

et al. 2023

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Transcatheter aortic valve implantation (TAVI) is an effective and established treatment for symptomatic aortic stenosis. However, there is a lack of consensus concerning the need for peri- and post-procedural anti-thrombotic medication. Contemporary guidelines recommend that anti-thrombotic therapy is balanced against a patient’s bleeding risk following TAVI, but do not fully consider the evolving evidence base. The purpose of the Delphi panel recommendations presented here is to provide a consensus elicited from a panel of experts who regularly prescribe anti-thrombotic therapy post-TAVI. The goal was to address evidence gaps across four key topics: anti-thrombotic therapy (anti-platelet and/or anti-coagulant) in TAVI patients in sinus rhythm; anti-thrombotic therapy in TAVI patients with AF; direct oral anti-coagulants versus vitamin K antagonists; and the need for UK/Ireland specific guidance. This consensus statement aims to inform clinical decision-making by providing a concise, evidence-based summary of best practice for prescribing anti-thrombotic therapies following TAVI and highlights areas where further research is needed.

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Apixaban and Valve Thrombosis After Transcatheter Aortic Valve Replacement

Cited by 40 publications

References 20 publications

Heart failure and excess mortality after aortic valve replacement in aortic stenosis

Heart failure and excess mortality after aortic valve replacement in aortic stenosis

Subclinical Leaflet Thrombosis and Anticoagulation After Transcatheter Aortic Valve Replacement

An Update on Anti-thrombotic Therapy Following Transcatheter Aortic Valve Implantation: Expert Cardiologist Opinion from a UK and Ireland Delphi Group

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