Anticoagulation Management After TAVI

Standard Antithrombotic Regimen After TAVI

The European Society of Cardiology recommends dual antiplatelet therapy with aspirin and clopidogrel for the first 3-6 months after TAVI in patients without other indications for oral anticoagulation 2
After the initial 3-6 month period, the European Society of Cardiology recommends continuing lifelong single antiplatelet therapy, typically with aspirin, in patients without other indications for oral anticoagulation 1, 2
For patients at high bleeding risk, the European Society of Cardiology suggests that single antiplatelet therapy alone may be considered immediately after TAVI 1, 2

The American Heart Association recommends lifelong oral anticoagulation for patients with indications such as atrial fibrillation, venous thromboembolism, or severely impaired LV function with EF <35% 1, 2, 3
For patients with mechanical valve prostheses, the American Heart Association recommends anticoagulation with a vitamin K antagonist (VKA) lifelong, with a target INR based on the specific valve type and position 3
The American Heart Association states that NOACs (non-vitamin K antagonist oral anticoagulants) are contraindicated in patients with mechanical valve prostheses 3

The European Society of Cardiology recommends adding clopidogrel to aspirin for patients who underwent TAVI within the past 3-6 months and are only on aspirin, to complete the recommended dual antiplatelet therapy period 1, 2
For patients who underwent TAVI more than 6 months ago, the European Society of Cardiology recommends continuing single antiplatelet therapy with aspirin alone 1, 2

The European Society of Cardiology suggests that bleeding risk should be carefully assessed when determining the optimal antithrombotic regimen, and that patients with high bleeding risk may benefit from single antiplatelet therapy rather than DAPT 1, 2
Factors that increase bleeding risk include advanced age, prior bleeding, renal impairment, liver disease, and concomitant use of medications that increase bleeding risk 1, 2

The European Society of Cardiology advises against using oral anticoagulation with VKA for the first 3 months after TAVI unless there are specific indications for anticoagulation 2
The American Heart Association states that rivaroxaban (10 mg daily) plus aspirin is contraindicated after bioprosthetic TAVI in the absence of other indications for oral anticoagulants 3
The European Society of Cardiology recommends avoiding the use of prasugrel or ticagrelor as part of triple therapy if anticoagulation is required 1
In patients requiring anticoagulation plus antiplatelet therapy, the European Society of Cardiology suggests keeping the INR in the lower part of the recommended target range to reduce bleeding risk 1
Regular monitoring for both thrombotic and bleeding complications is essential, especially during the first year after TAVI, according to the European Society of Cardiology 1, 2