Optimal antithrombotic therapy after transcatheter aortic valve replacement in patients with atrial fibrillation

Abstract

Atrial fibrillation (AF) is prevalent in patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Depending on the timing of AF detection, it is usually categorized as pre-existing AF or new-onset AF. Antiplatelet therapy, rather than a vitamin K antagonist, may be considered as the primary treatment for patients without an indication for oral anticoagulants who undergo TAVR. However, the optimal postprocedural antithrombotic regimen for patients with AF undergoing TAVR remains unknown. In this review, we briefly introduce the management strategies of antithrombotic therapy and list the evidence from related studies to elucidate the optimal antithrombotic management for patients with AF undergoing TAVR.

Pre-operative and post-operative atrial fibrillation in patients undergoing SAVR/TAVR

“…In terms of specific anticoagulant treatment, there is a lack of established consistency in clinical studies. Some studies recommend the use of a combination of an oral anticoagulant like warfarin and an antiplatelet drug such as aspirin or clopidogrel [26,60] . However, other studies have shown oral anticoagulant monotherapy to be safe with a lower risk of major bleeding complications than a combined therapy of an oral anticoagulant and an antiplatelet drug [61] .…”