Post-TAVR Medical Management

Antithrombotic Therapy

The American College of Cardiology recommends aspirin 75-100 mg daily lifelong for patients post-TAVR 1, 2
The American College of Cardiology suggests clopidogrel 75 mg daily for 3-6 months for patients post-TAVR 1, 3
Consider warfarin (INR 2.0-2.5) if patient is at risk of atrial fibrillation or venous thromboembolism, as recommended by the American College of Cardiology 1, 4

The American College of Cardiology recommends TAVR team evaluation at 30 days post-procedure 1, 5
Primary cardiologist follow-up is recommended at 6 months and then annually, according to the American College of Cardiology 1, 6
Primary care physician or geriatrician follow-up is recommended at 3 months and then as needed, as suggested by the American College of Cardiology 1, 7

Echocardiography is recommended at 30 days post-procedure and then annually as needed, according to the American College of Cardiology 1, 8
ECG is recommended at 30 days and annually, as suggested by the American College of Cardiology 1, 8
Consider 24-hour ECG monitoring if bradycardia is present, as recommended by the American College of Cardiology 1, 8

Optimize treatment of coronary artery disease, as recommended by the American College of Cardiology 1, 9
Control hypertension, according to the American College of Cardiology 1, 9
Manage heart failure, as suggested by the American College of Cardiology 1, 9

Encourage optimal dental care, as recommended by the American College of Cardiology 1, 8
Provide antibiotic prophylaxis according to AHA/ACC guidelines, as suggested by the American College of Cardiology 1, 8

Early mobilization post-procedure is crucial, especially in elderly patients with multiple comorbidities, according to the American College of Cardiology 5
Readmission rates exceed 40% in the first year after TAVR, most often due to non-cardiac causes, as reported by the American College of Cardiology 9

Regular assessment of prosthetic valve function is essential, as recommended by the American College of Cardiology 1, 2, 3

Promote physical activity as appropriate for the patient's condition, as suggested by the American College of Cardiology 1, 5
Consider formal cardiac rehabilitation programs, especially for deconditioned patients, according to the American College of Cardiology 5

The American College of Cardiology recommends aspirin 75-100 mg daily lifelong, with clopidogrel 75 mg daily added for 3-6 months in patients without an indication for anticoagulation 10
Anticoagulation per atrial fibrillation guidelines for prosthetic heart valves is mandatory, with vitamin K antagonist therapy (INR 2.0-2.5) considered, particularly in the first 3 months 10
Continuation of aspirin with anticoagulation is reasonable, but avoid adding clopidogrel due to excessive bleeding risk with triple therapy 10

A pre-discharge echocardiogram should be performed to establish baseline, including transvalvular velocity, mean gradient, valve area, and paravalvular regurgitation assessment 10
Repeat echocardiography at 30 days, then annually, to monitor for complications, assess valve durability, and guide medical therapy for concurrent conditions 10
Key parameters to assess include LV size and function, regional wall motion, mitral valve function, pulmonary pressures, and right ventricular function 10

Implement guideline-directed medical therapy for heart failure/LV dysfunction, as recommended by the American College of Cardiology 10
Manage mitral valve disease and pulmonary hypertension as indicated by serial echocardiography, according to American College of Cardiology guidelines 10

Standard antibiotic prophylaxis per AHA/ACC guidelines for all prosthetic valves should be followed, as recommended by the American Heart Association and American College of Cardiology 10
Encourage optimal dental hygiene and regular dental visits for routine cleaning and care, as advised by the American College of Cardiology 10

Do not use triple therapy (anticoagulation + dual antiplatelet) except in extraordinary circumstances due to prohibitive bleeding risk, as warned by the American College of Cardiology 10
Do not neglect late conduction abnormalities—pacemaker needs can emerge beyond the initial 30-day period, according to American College of Cardiology guidelines 10
Do not assume valve durability is indefinite—annual surveillance for structural valve deterioration is essential as long-term durability data remain limited, as recommended by the American College of Cardiology 10