జర్నల్ ఆఫ్ కార్డియాక్ అండ్ పల్మనరీ రిహాబిలిటేషన్

నైరూప్య

Antithrombotic Therapy in Transcatheter Aortic Valve Replacement Patients without an Indication for Oral Anticoagulation: Insights from the GALILEO and ATLANTIS Trials

Ranbir Singh1,2, Johny Nicolas2 and George Dangas2

Transcatheter aortic valve replacement (TAVR) is a plausible therapeutic approach in patients with symptomatic aortic stenosis. Antithrombotic therapy after TAVR is of utmost importance to prevent thrombo-embolic complications. Few randomized trials investigating antithrombotic therapy in TAVR patients without an indication for chronic oral anticoagulation have been reported. GALILEO compared an intermediate-dose (10mg daily) rivaroxaban to a clopidogrel-based strategy after successful TAVR; ATLANTIS recently reported results with full-dose apixaban anticoagulation versus a similar control group. In the former trial, there was increased major bleeding with anticoagulation versus control, whereas this was not apparent in the latter. In both trials, the anticoagulation-based treatment strategy was associated with a higher risk of mortality, including non-cardiovascular death, when compared to an antiplatelet based strategy. Both trials showed decreased risk of bio prosthetic valve leaflet thrombosis with anticoagulation versus control, as assessed with 4-dimensional computerized tomographic angiography. Further studies are needed to elucidate the clinical significance of subclinical leaflet thrombosis, its relation to valve durability, and enhance our understanding of the risk-benefit tradeoff in post-TAVR antithrombotic therapy.