Antithrombotic Therapy Post-TAVR

Standard Regimen

• The American College of Cardiology recommends aspirin 75-100 mg daily lifelong and clopidogrel 75 mg daily for 3-6 months post-TAVR for patients without an indication for anticoagulation 1, 2
• This dual antiplatelet therapy regimen was used in the original TAVR clinical trials to minimize thromboembolism risk 3

Anticoagulation for Patients With Indication

• For patients with an indication for anticoagulation, such as atrial fibrillation, the American Heart Association recommends vitamin K antagonist, such as warfarin, with a target INR of 2.0-2.5 for the first 3 months post-TAVR 4, 5
• After 3 months, patients with long-term indications for anticoagulation may transition to a direct oral anticoagulant (DOAC) 4, 5

Special Considerations

• The American College of Cardiology advises against the use of DOACs in patients with mechanical valve prostheses 3, 6
• For bioprosthetic valves, including TAVR, warfarin with an INR target of 2.5 (range 2.0-3.0) may be reasonable for the first 3 months 7, 3

Monitoring

• The American College of Cardiology recommends echocardiography at 30 days post-TAVR and then annually, as well as ECG at 30 days and annually 1, 2
• Monitoring for bleeding complications, especially with combination antithrombotic therapy, is crucial 4