Thrombus Formation Following Transcatheter Aortic Valve Replacement

Marchena, Eduardo de; Mesa, Julian; Pomenti, Sydney; Kall, Christian Marin y; Marincic, Ximena; Yahagi, Kazuyuki; Ladich, Elena; Kutys, Robert; Aga, Yaar; Ragosta, Michael; Chawla, Atul; Ring, Michael E.; Virmani, Renu

doi:10.1016/j.jcin.2015.03.005

Cited by 153 publications

(103 citation statements)

References 28 publications

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“…The frequency of leaflet thrombosis, including symptomatic cases, varied widely from 0.19% to 40%. According to one case report, time of onset varies widely from 3 days to 2 years after procedure 13. When these literature references are combined, subclinical leaflet thrombosis seems to be observed 1–3 months after TAVI with the incidence up to about 10%–15% 14 15.…”

Section: Incidencementioning

confidence: 99%

Subclinical leaflet thrombosis after transcatheter aortic valve implantation

Nakatani

2017

Heart

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Although clinically significant valve thrombosis after transcatheter aortic valve implantation (TAVI) is rare, the incidence of subclinical leaflet thrombosis has been reported to be up to about 10%-15%. It is mostly found 1-3 months after procedure in any type of transcatheter heart valve. Leaflet thrombosis is detected by high-resolution CT in the form of limited valve opening/closure and hypoattenuated leaflet thickening. Transthoracic or transesophageal echocardiography is capable of detecting limitations of valve motion, leaflet thickening, increased flow velocity across the valve. However, CT seems to be more sensitive than echocardiography to detect leaflet thrombosis. It can occur under dual antiplatelet therapy with aspirin and a thienopyridine but rarely occurs with anticoagulation with a vitamin K antagonist. A vitamin K antagonist is also helpful to resolve leaflet thrombosis. Several studies are ongoing to determine the effect of new oral anticoagulants (NOACs) in preventing major cardiovascular events. They will also provide useful information on whether NOACs prevent leaflet thrombosis.

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Section: Incidencementioning

confidence: 99%

Subclinical leaflet thrombosis after transcatheter aortic valve implantation

Nakatani

2017

Heart

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“…Some studies found that patients undergoing TAVI had valve thrombosis, characterized by reduced leaflet motion, increased mean pressure gradients, and imaging abnormalities [13, 14, 36-38]. These studies demonstrated that oral anticoagulants have a protective effect.…”

Section: Discussionmentioning

confidence: 99%

“…Some factors may be considered responsible for valve thrombosis, such as inadequate antiplatelet therapy, patients’ hypercoagulability, atrial fibrillation, endothelial injury produced by balloon predilation, and valve malposition, etc. [13, 36-38]. Thus, we should evaluate the condition of patients and their valve function to decide whether oral anticoagulants are needed.…”

Section: Discussionmentioning

confidence: 99%

Single versus Dual Antiplatelet Therapy after Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis

Yang

Wang

et al. 2018

Cardiology

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Objectives: Although dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is currently recommended in patients after transcatheter aortic valve implantation (TAVI), this practice is not supported by sufficient evidence. This study was performed to compare DAPT to single antiplatelet therapy (SAPT). Methods: An electronic search was completed of PubMed, Embase, Ovid Medline, Web of Science, and Cochrane Central Register of Controlled Trials. Studies comparing DAPT versus SAPT in patients undergoing TAVI were included. Results: Seven studies incorporating 1,445 patients were eligible for the present meta-analysis. There were no significant differences on 30-day all-cause mortality (OR 1.19, 95% CI 0.63–2.25, p = 0.593), 6-month all-cause mortality (OR 1.11, 95% CI 0.49–2.53, p = 0.796), or 1-year all-cause mortality (OR 1.19, 95% CI 0.63- 2.25, p = 0.593). DAPT was associated with an increased risk for 30-day (OR 2.91, 95% CI 1.85–4.58, p < 0.01), 6-month (OR 2.54, 95% CI 1.26–5.10, p < 0.001), and 1-year major and lethal bleeding (OR 2.65, 95% CI 1.04–6.77, p = 0.041) based on 896, 337, and 583 patients, respectively, compared to SAPT. Conclusion: Compared to SAPT, DAPT was not shown to be superior in reducing thrombotic events, but presented an increased risk of major/life-threatening bleeding. More randomized controlled trials are needed to provide further evidence.

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“…In the relatively young era of percutaneous aortic valve replacement, an increasing number of reports has emerged describing cases of clinically relevant subacute post-TAVR valve thrombosis and recently identified reduced leaflet motion in MDCT, which may correspond to a subclinical surrogate of valve thrombosis [10,11,[23][24][25]. These reports about post-TAVR valve thrombosis and hindered leaflet function have generated debate about the clinical relevance of this phenomenon.…”

Section: Discussionmentioning

confidence: 99%