Antiplatelet Therapy After Device Closure of ASD and VSD

Introduction to Antiplatelet Therapy

• The European Society of Cardiology recommends antiplatelet therapy for at least 6 months with aspirin 100 mg daily minimum after device closure 1, 2
• Children should receive oral antiplatelet therapy with low-dose aspirin for at least 6 months after implantation (Class I, Level of Evidence C) 3, 4

For ASD Device Closure

• All patients undergoing device closure should receive at least 100 U/kg UFH (up to 5000-U maximum dose) at the time of implantation (Class I, Level of Evidence C) 3, 4
• For older children and adults, another anticoagulant may be considered in addition to aspirin for 3 to 6 months after implantation (Class IIb, Level of Evidence C) 3, 4

For VSD Device Closure

• It is reasonable to treat children undergoing device closure of ventricular septal defects with oral antiplatelet therapy with low-dose aspirin for at least 6 months after implantation (Class IIa, Level of Evidence C) 5, 6
• Children undergoing device closure of VSDs should receive UFH 100 U/kg (up to 5000-U maximum dose) at the time of implantation (Class I, Level of Evidence C) 5, 6

Rationale for Antiplatelet Therapy

• The duration of thromboprophylaxis theoretically should extend until complete device endothelialization is achieved, which is the basis for the standard 6-month duration 3, 4
• If complete defect closure is not achieved (residual defect after device implantation), many elect to continue thromboprophylaxis beyond 6 months because there is an ongoing risk of paradoxical embolus 3, 4

High-Risk Patient Considerations

• In higher-risk patients such as those with a history of stroke, inherited thrombophilic disorders should be excluded before device implantation so that antithrombotic prophylaxis can be adapted accordingly 3, 4

Critical Pitfalls to Avoid

• Do not omit antiplatelet therapy entirely, as this is standard of care despite the extremely low incidence of device thrombosis 1, 2, 3, 4
• Do not discontinue aspirin before 6 months unless there are compelling contraindications, as complete endothelialization requires this duration 3, 4
• Do not forget procedural anticoagulation with UFH at the time of device implantation, which is a Class I recommendation 3, 4, 5