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Adjunctive Antithrombotic Therapy for Patients With Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

Educational Objective To delineate the role of anticoagulation for prevention of stroke in the setting of transcatheter aortic valve replacement.
1 Credit CME
Abstract

Importance  Transcatheter aortic valve replacement (TAVR) is an established alternative to surgery for patients with severe symptomatic aortic stenosis. Adjunctive antithrombotic therapy used to mitigate thrombotic risks in patients undergoing TAVR must be balanced against bleeding complications, since both are associated with increased mortality.

Observation  Stroke risk associated with TAVR is lower than that associated with surgical aortic valve replacement in recent trials including patients at intermediate or low risk, but it is constant beginning at the time of implant and accrues over time based on patient risk factors. Patients with aortic stenosis undergoing TAVR also have a sizable risk of life-threatening or major bleeding. Although dual antiplatelet therapy for 3 to 6 months after TAVR is the guideline-recommended regimen, this practice is not well supported by current evidence. In patients with no indication for oral anticoagulation, current registry-based evidence suggests that single antiplatelet therapy may be safer than dual antiplatelet therapy. Similarly, oral anticoagulation monotherapy appears superior to anticoagulation plus antiplatelet therapy in those where oral anticoagulant use is indicated. To date, no risk prediction models have been established to guide antithrombotic therapy.

Conclusions and Relevance  Despite the growing volume of TAVR procedures to treat patients with severe aortic stenosis, evidence for adjunctive antithrombotic therapy remains rather scarce. Ongoing clinical trials will provide better understanding to guide antithrombotic therapy.

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Article Information

Accepted for Publication: September 20, 2019.

Corresponding Author: Alexandra Lansky, MD, Division of Cardiovascular Medicine, Yale School of Medicine, 135 College St, Ste 101, New Haven, CT 06510 (alexandra.lansky@yale.edu).

Published Online: November 13, 2019. doi:10.1001/jamacardio.2019.4367

Author Contributions: Drs Saito and Lansky had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Saito, Nazif, Baumbach, Tchétché, Latib, Forrest, Prendergast, Lansky.

Acquisition, analysis, or interpretation of data: Saito, Tchétché, Kaple, Forrest.

Drafting of the manuscript: Saito, Latib, Forrest.

Critical revision of the manuscript for important intellectual content: Nazif, Baumbach, Tchétché, Latib, Kaple, Forrest, Prendergast, Lansky.

Administrative, technical, or material support: Latib, Forrest.

Supervision: Latib, Forrest.

Conflict of Interest Disclosures: Dr Nazif reports grants, personal fees, and nonfinancial support from Edwards Lifesciences, Medtronic, and Boston Scientific outside the submitted work. Dr Latib is on the advisory boards of Medtronic and Abbott and reported personal fees from Medtronic, Abbott, and Edwards Lifesciences outside the submitted work. Dr Forrest reports personal fees and grants from Edwards Lifesciences and Medtronic outside the submitted work. Dr Lansky reports grants from Abbott Vascular and personal fees from Venous Medical/Keystone Heart, KSH, Microport, Sinomed, and AstraZeneca outside the submitted work. Dr Saito reported grants from SENSHIN Medical Research Foundation outside the submitted work. Dr Baumbach reported grants and personal fees from Abbott and personal fees from AstraZeneca, Microport, and Sinomed outside the submitted work. No other disclosures were reported.

References
1.
Nkomo  VT, Gardin  JM, Skelton  TN, Gottdiener  JS, Scott  CG, Enriquez-Sarano  M.  Burden of valvular heart diseases: a population-based study.  Lancet. 2006;368(9540):1005-1011. doi:10.1016/S0140-6736(06)69208-8PubMedGoogle ScholarCrossref
2.
Nishimura  RA, Otto  CM, Bonow  RO,  et al.  2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.  J Am Coll Cardiol. 2017;70(2):252-289. doi:10.1016/j.jacc.2017.03.011PubMedGoogle ScholarCrossref
3.
Baumgartner  H, Falk  V, Bax  JJ,  et al; ESC Scientific Document Group.  2017 ESC/EACTS guidelines for the management of valvular heart disease.  Eur Heart J. 2017;38(36):2739-2791. doi:10.1093/eurheartj/ehx391PubMedGoogle ScholarCrossref
4.
Smith  CR, Leon  MB, Mack  MJ,  et al; PARTNER Trial Investigators.  Transcatheter versus surgical aortic-valve replacement in high-risk patients.  N Engl J Med. 2011;364(23):2187-2198. doi:10.1056/NEJMoa1103510PubMedGoogle ScholarCrossref
5.
Leon  MB, Smith  CR, Mack  M,  et al; PARTNER Trial Investigators.  Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery.  N Engl J Med. 2010;363(17):1597-1607. doi:10.1056/NEJMoa1008232PubMedGoogle ScholarCrossref
6.
Thyregod  HG, Steinbrüchel  DA, Ihlemann  N,  et al.  Transcatheter versus surgical aortic valve replacement in patients with severe aortic valve stenosis: 1-year results from the All-Comers NOTION randomized clinical trial.  J Am Coll Cardiol. 2015;65(20):2184-2194. doi:10.1016/j.jacc.2015.03.014PubMedGoogle ScholarCrossref
7.
Adams  DH, Popma  JJ, Reardon  MJ,  et al; U.S. CoreValve Clinical Investigators.  Transcatheter aortic-valve replacement with a self-expanding prosthesis.  N Engl J Med. 2014;370(19):1790-1798. doi:10.1056/NEJMoa1400590PubMedGoogle ScholarCrossref
8.
Leon  MB, Smith  CR, Mack  MJ,  et al; PARTNER 2 Investigators.  Transcatheter or surgical aortic-valve replacement in intermediate-risk patients.  N Engl J Med. 2016;374(17):1609-1620. doi:10.1056/NEJMoa1514616PubMedGoogle ScholarCrossref
9.
Reardon  MJ, Van Mieghem  NM, Popma  JJ,  et al; SURTAVI Investigators.  Surgical or transcatheter aortic-valve replacement in intermediate-risk patients.  N Engl J Med. 2017;376(14):1321-1331. doi:10.1056/NEJMoa1700456PubMedGoogle ScholarCrossref
10.
Mack  MJ, Leon  MB, Thourani  VH,  et al; PARTNER 3 Investigators.  Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients.  N Engl J Med. 2019;380(18):1695-1705. doi:10.1056/NEJMoa1814052PubMedGoogle ScholarCrossref
11.
Popma  JJ, Deeb  GM, Yakubov  SJ,  et al; Evolut Low Risk Trial Investigators.  Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients.  N Engl J Med. 2019;380(18):1706-1715. doi:10.1056/NEJMoa1816885PubMedGoogle ScholarCrossref
12.
Linke  A, Wenaweser  P, Gerckens  U,  et al; ADVANCE study Investigators.  Treatment of aortic stenosis with a self-expanding transcatheter valve: the International Multi-centre ADVANCE Study.  Eur Heart J. 2014;35(38):2672-2684. doi:10.1093/eurheartj/ehu162PubMedGoogle ScholarCrossref
13.
Bleiziffer  S, Bosmans  J, Brecker  S,  et al; ADVANCE Study Investigators.  Insights on mid-term TAVR performance: 3-year clinical and echocardiographic results from the CoreValve ADVANCE study.  Clin Res Cardiol. 2017;106(10):784-795. doi:10.1007/s00392-017-1120-3PubMedGoogle ScholarCrossref
14.
Schymik  G, Lefèvre  T, Bartorelli  AL,  et al.  European experience with the second-generation Edwards SAPIEN XT transcatheter heart valve in patients with severe aortic stenosis: 1-year outcomes from the SOURCE XT Registry.  JACC Cardiovasc Interv. 2015;8(5):657-669. doi:10.1016/j.jcin.2014.10.026PubMedGoogle ScholarCrossref
15.
Gilard  M, Eltchaninoff  H, Donzeau-Gouge  P,  et al; FRANCE 2 Investigators.  Late outcomes of transcatheter aortic valve replacement in high-risk patients: the FRANCE-2 registry.  J Am Coll Cardiol. 2016;68(15):1637-1647. doi:10.1016/j.jacc.2016.07.747PubMedGoogle ScholarCrossref
16.
Hira  RS, Vemulapalli  S, Li  Z,  et al.  Trends and outcomes of off-label use of transcatheter aortic valve replacement: insights from the NCDR STS/ACC TVT registry.  JAMA Cardiol. 2017;2(8):846-854. doi:10.1001/jamacardio.2017.1685PubMedGoogle ScholarCrossref
17.
Carroll  JD, Vemulapalli  S, Dai  D,  et al.  Procedural experience for transcatheter aortic valve replacement and relation to outcomes: the STS/ACC TVT registry.  J Am Coll Cardiol. 2017;70(1):29-41. doi:10.1016/j.jacc.2017.04.056PubMedGoogle ScholarCrossref
18.
Stortecky  S, Franzone  A, Heg  D,  et al.  Temporal trends in adoption and outcomes of transcatheter aortic valve implantation: a SwissTAVI Registry analysis.  Eur Heart J Qual Care Clin Outcomes. 2019;5(3):242-251. doi:10.1093/ehjqcco/qcy048PubMedGoogle ScholarCrossref
19.
Chieffo  A, Petronio  AS, Mehilli  J,  et al; WIN-TAVI Investigators.  1-Year clinical outcomes in women after transcatheter aortic valve replacement: results from the first WIN-TAVI registry.  JACC Cardiovasc Interv. 2018;11(1):1-12. doi:10.1016/j.jcin.2017.09.034PubMedGoogle ScholarCrossref
20.
Wendler  O, Schymik  G, Treede  H,  et al.  SOURCE 3 registry: design and 30-day results of the european postapproval registry of the latest generation of the SAPIEN 3 transcatheter heart valve.  Circulation. 2017;135(12):1123-1132. doi:10.1161/CIRCULATIONAHA.116.025103PubMedGoogle ScholarCrossref
21.
Wendler  O, Schymik  G, Treede  H,  et al.  SOURCE 3: 1-year outcomes post-transcatheter aortic valve implantation using the latest generation of the balloon-expandable transcatheter heart valve.  Eur Heart J. 2017;38(36):2717-2726. doi:10.1093/eurheartj/ehx294PubMedGoogle ScholarCrossref
22.
Manoharan  G, Van Mieghem  NM, Windecker  S,  et al.  1-Year outcomes with the Evolut R self-expanding transcatheter aortic valve: from the international FORWARD study.  JACC Cardiovasc Interv. 2018;11(22):2326-2334. doi:10.1016/j.jcin.2018.07.032PubMedGoogle ScholarCrossref
23.
Cerrato  E, Nombela-Franco  L, Nazif  TM,  et al.  Evaluation of current practices in transcatheter aortic valve implantation: the WRITTEN (Worldwide TAVI Experience) survey.  Int J Cardiol. 2017;228:640-647. doi:10.1016/j.ijcard.2016.11.104PubMedGoogle ScholarCrossref
24.
Ahmad  Y, Demir  O, Rajkumar  C,  et al.  Optimal antiplatelet strategy after transcatheter aortic valve implantation: a meta-analysis.  Open Heart. 2018;5(1):e000748. doi:10.1136/openhrt-2017-000748PubMedGoogle Scholar
25.
Durko  AP, Reardon  MJ, Kleiman  NS,  et al.  Neurological complications after transcatheter versus surgical aortic valve replacement in intermediate-risk patients.  J Am Coll Cardiol. 2018;72(18):2109-2119. doi:10.1016/j.jacc.2018.07.093PubMedGoogle ScholarCrossref
26.
Lansky  AJ, Ghare  MI, Pietras  C.  Carotid disease and stroke after transcatheter aortic valve replacement.  Circ Cardiovasc Interv. 2018;11(6):e006826. doi:10.1161/CIRCINTERVENTIONS.118.006826PubMedGoogle Scholar
27.
Bosmans  J, Bleiziffer  S, Gerckens  U,  et al; ADVANCE Study Investigators.  The incidence and predictors of early- and mid-term clinically relevant neurological events after transcatheter aortic valve replacement in real-world patients.  J Am Coll Cardiol. 2015;66(3):209-217. doi:10.1016/j.jacc.2015.05.025PubMedGoogle ScholarCrossref
28.
Nombela-Franco  L, Webb  JG, de Jaegere  PP,  et al.  Timing, predictive factors, and prognostic value of cerebrovascular events in a large cohort of patients undergoing transcatheter aortic valve implantation.  Circulation. 2012;126(25):3041-3053. doi:10.1161/CIRCULATIONAHA.112.110981PubMedGoogle ScholarCrossref
29.
Kahlert  P, Al-Rashid  F, Döttger  P,  et al.  Cerebral embolization during transcatheter aortic valve implantation: a transcranial Doppler study.  Circulation. 2012;126(10):1245-1255. doi:10.1161/CIRCULATIONAHA.112.092544PubMedGoogle ScholarCrossref
30.
Vranckx  P, Windecker  S, Welsh  RC, Valgimigli  M, Mehran  R, Dangas  G.  Thrombo-embolic prevention after transcatheter aortic valve implantation.  Eur Heart J. 2017;38(45):3341-3350. doi:10.1093/eurheartj/ehx390PubMedGoogle ScholarCrossref
31.
Lansky  AJ, Schofer  J, Tchetche  D,  et al.  A prospective randomized evaluation of the TriGuard™ HDH embolic DEFLECTion device during transcatheter aortic valve implantation: results from the DEFLECT III trial.  Eur Heart J. 2015;36(31):2070-2078. doi:10.1093/eurheartj/ehv191PubMedGoogle ScholarCrossref
32.
Auffret  V, Regueiro  A, Del Trigo  M,  et al.  Predictors of early cerebrovascular events in patients with aortic stenosis undergoing transcatheter aortic valve replacement.  J Am Coll Cardiol. 2016;68(7):673-684. doi:10.1016/j.jacc.2016.05.065PubMedGoogle ScholarCrossref
33.
Tay  EL, Gurvitch  R, Wijesinghe  N,  et al.  A high-risk period for cerebrovascular events exists after transcatheter aortic valve implantation  [correction published in JACC Cardiovasc Interv. 2012;5(2):248].  JACC Cardiovasc Interv. 2011;4(12):1290-1297. doi:10.1016/j.jcin.2011.08.012PubMedGoogle ScholarCrossref
34.
Lansky  A, Ghare  MI, Tchétché  D, Baumbach  A.  TAVI and the brain: update on definitions, evidence of neuroprotection and adjunctive pharmacotherapy.  EuroIntervention. 2018;14(AB):AB53-AB63. doi:10.4244/EIJ-D-18-00454PubMedGoogle ScholarCrossref
35.
Kleiman  NS, Maini  BJ, Reardon  MJ,  et al; CoreValve Investigators.  Neurological events following transcatheter aortic valve replacement and their predictors: a report from the CoreValve trials.  Circ Cardiovasc Interv. 2016;9(9):e003551. doi:10.1161/CIRCINTERVENTIONS.115.003551PubMedGoogle Scholar
36.
Kapadia  S, Agarwal  S, Miller  DC,  et al.  Insights into timing, risk factors, and outcomes of stroke and transient ischemic attack after transcatheter aortic valve replacement in the PARTNER trial (Placement of Aortic Transcatheter Valves).  Circ Cardiovasc Interv. 2016;9(9):e002981. doi:10.1161/CIRCINTERVENTIONS.115.002981PubMedGoogle Scholar
37.
Conrotto  F, D’Ascenzo  F, D’Onofrio  A,  et al.  Predictive ability of the CHADS2 and CHA2DS2-VASc scores for stroke after transcatheter aortic balloon-expandable valve implantation: an Italian Transcatheter Balloon-Expandable Valve Implantation Registry (ITER) sub-analysis.  Eur J Cardiothorac Surg. 2016;50(5):867-873. doi:10.1093/ejcts/ezw199PubMedGoogle ScholarCrossref
38.
Tarantini  G, Mojoli  M, Urena  M, Vahanian  A.  Atrial fibrillation in patients undergoing transcatheter aortic valve implantation: epidemiology, timing, predictors, and outcome.  Eur Heart J. 2017;38(17):1285-1293.PubMedGoogle Scholar
39.
Figini  F, Latib  A, Maisano  F,  et al.  Managing patients with an indication for anticoagulant therapy after transcatheter aortic valve implantation.  Am J Cardiol. 2013;111(2):237-242. doi:10.1016/j.amjcard.2012.09.023PubMedGoogle ScholarCrossref
40.
Mojoli  M, Gersh  BJ, Barioli  A,  et al.  Impact of atrial fibrillation on outcomes of patients treated by transcatheter aortic valve implantation: a systematic review and meta-analysis.  Am Heart J. 2017;192:64-75. doi:10.1016/j.ahj.2017.07.005PubMedGoogle ScholarCrossref
41.
Chakravarty  T, Søndergaard  L, Friedman  J,  et al; RESOLVE; SAVORY Investigators.  Subclinical leaflet thrombosis in surgical and transcatheter bioprosthetic aortic valves: an observational study.  Lancet. 2017;389(10087):2383-2392. doi:10.1016/S0140-6736(17)30757-2PubMedGoogle ScholarCrossref
42.
Piccolo  R, Pilgrim  T, Franzone  A,  et al.  Frequency, timing, and impact of access-site and non-access-site bleeding on mortality among patients undergoing transcatheter aortic valve replacement.  JACC Cardiovasc Interv. 2017;10(14):1436-1446. doi:10.1016/j.jcin.2017.04.034PubMedGoogle ScholarCrossref
43.
Généreux  P, Cohen  DJ, Mack  M,  et al.  Incidence, predictors, and prognostic impact of late bleeding complications after transcatheter aortic valve replacement.  J Am Coll Cardiol. 2014;64(24):2605-2615. doi:10.1016/j.jacc.2014.08.052PubMedGoogle ScholarCrossref
44.
Kibler  M, Marchandot  B, Messas  N,  et al.  Primary hemostatic disorders and late major bleeding after transcatheter aortic valve replacement.  J Am Coll Cardiol. 2018;72(18):2139-2148. doi:10.1016/j.jacc.2018.08.2143PubMedGoogle ScholarCrossref
45.
Généreux  P, Cohen  DJ, Williams  MR,  et al.  Bleeding complications after surgical aortic valve replacement compared with transcatheter aortic valve replacement: insights from the PARTNER I Trial (Placement of Aortic Transcatheter Valve).  J Am Coll Cardiol. 2014;63(11):1100-1109. doi:10.1016/j.jacc.2013.10.058PubMedGoogle ScholarCrossref
46.
Sun  Y, Liu  X, Chen  Z,  et al.  Meta-analysis of predictors of early severe bleeding in patients who underwent transcatheter aortic valve implantation.  Am J Cardiol. 2017;120(4):655-661. doi:10.1016/j.amjcard.2017.05.035PubMedGoogle ScholarCrossref
47.
Faroux  L, Guimaraes  L, Wintzer-Wehekind  J,  et al.  Coronary artery disease and transcatheter aortic valve replacement: JACC state-of-the-art review.  J Am Coll Cardiol. 2019;74(3):362-372. doi:10.1016/j.jacc.2019.06.012PubMedGoogle ScholarCrossref
48.
Valgimigli  M, Bueno  H, Byrne  RA,  et al; ESC Scientific Document Group; ESC Committee for Practice Guidelines (CPG); ESC National Cardiac Societies.  2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: the task force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS).  Eur Heart J. 2018;39(3):213-260. doi:10.1093/eurheartj/ehx419PubMedGoogle ScholarCrossref
49.
Levine  GN, Bates  ER, Bittl  JA,  et al.  2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.  J Am Coll Cardiol. 2016;68(10):1082-1115. doi:10.1016/j.jacc.2016.03.513PubMedGoogle ScholarCrossref
50.
Lip  GYH, Collet  JP, de Caterina  R,  et al.  Antithrombotic therapy in atrial fibrillation associated with valvular heart disease: executive summary of a Joint Consensus Document from the European Heart Rhythm Association (EHRA) and European Society of Cardiology Working Group on Thrombosis, Endorsed by the ESC Working Group on Valvular Heart Disease, Cardiac Arrhythmia Society of Southern Africa (CASSA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), South African Heart (SA Heart) Association and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE).  Thromb Haemost. 2017;117(12):2215-2236. doi:10.1160/TH-17-10-0709PubMedGoogle ScholarCrossref
51.
Lopes  RD, Heizer  G, Aronson  R,  et al; AUGUSTUS Investigators.  Antithrombotic therapy after acute coronary syndrome or PCI in atrial fibrillation.  N Engl J Med. 2019;380(16):1509-1524. doi:10.1056/NEJMoa1817083PubMedGoogle ScholarCrossref
52.
Lip  GYH, Collet  JP, Haude  M,  et al; ESC Scientific Document Group.  2018 Joint European consensus document on the management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous cardiovascular interventions: a joint consensus document of the European Heart Rhythm Association (EHRA), European Society of Cardiology Working Group on Thrombosis, European Association of Percutaneous Cardiovascular Interventions (EAPCI), and European Association of Acute Cardiac Care (ACCA) endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), Latin America Heart Rhythm Society (LAHRS), and Cardiac Arrhythmia Society of Southern Africa (CASSA).  Europace. 2019;21(2):192-193. doi:10.1093/europace/euy174PubMedGoogle ScholarCrossref
53.
Hioki  H, Watanabe  Y, Kozuma  K,  et al; OCEAN-TAVI investigators.  Pre-procedural dual antiplatelet therapy in patients undergoing transcatheter aortic valve implantation increases risk of bleeding.  Heart. 2017;103(5):361-367. doi:10.1136/heartjnl-2016-309735PubMedGoogle ScholarCrossref
54.
Nijenhuis  VJ, Ten Berg  JM, Hengstenberg  C,  et al.  Usefulness of clopidogrel loading in patients who underwent transcatheter aortic valve implantation (from the BRAVO-3 randomized trial).  Am J Cardiol. 2019;123(9):1494-1500. doi:10.1016/j.amjcard.2019.01.049PubMedGoogle ScholarCrossref
55.
Brinkert  M, Keller  LS, Moriyama  N,  et al.  Safety and efficacy of transcatheter aortic valve replacement with continuation of oral anticoagulation.  J Am Coll Cardiol. 2019;73(15):2004-2005. doi:10.1016/j.jacc.2018.11.066PubMedGoogle ScholarCrossref
56.
Dangas  GD, Lefèvre  T, Kupatt  C,  et al; BRAVO-3 Investigators.  Bivalirudin versus heparin anticoagulation in transcatheter aortic valve replacement: the randomized BRAVO-3 trial.  J Am Coll Cardiol. 2015;66(25):2860-2868. doi:10.1016/j.jacc.2015.10.003PubMedGoogle ScholarCrossref
57.
Rodés-Cabau  J, Masson  JB, Welsh  RC,  et al.  Aspirin versus aspirin plus clopidogrel as antithrombotic treatment following transcatheter aortic valve replacement with a balloon-expandable valve: the ARTE (Aspirin Versus Aspirin + Clopidogrel Following Transcatheter Aortic Valve Implantation) randomized clinical trial.  JACC Cardiovasc Interv. 2017;10(13):1357-1365. doi:10.1016/j.jcin.2017.04.014PubMedGoogle ScholarCrossref
58.
D’Ascenzo  F, Benedetto  U, Bianco  M,  et al.  Which is the best antiaggregant or anticoagulant therapy after TAVI? a propensity-matched analysis from the ITER registry: the management of DAPT after TAVI.  EuroIntervention. 2017;13(12):e1392-e1400. doi:10.4244/EIJ-D-17-00198PubMedGoogle ScholarCrossref
59.
Maes  F, Stabile  E, Ussia  GP,  et al.  Meta-analysis comparing single versus dual antiplatelet therapy following transcatheter aortic valve implantation.  Am J Cardiol. 2018;122(2):310-315. doi:10.1016/j.amjcard.2018.04.006PubMedGoogle ScholarCrossref
60.
Al Halabi  S, Newman  J, Farkouh  ME,  et al.  Meta-analysis of studies comparing dual- versus mono-antiplatelet therapy following transcatheter aortic valve implantation.  Am J Cardiol. 2018;122(1):141-148. doi:10.1016/j.amjcard.2018.03.019PubMedGoogle ScholarCrossref
61.
Sherwood  MW, Vemulapalli  S, Harrison  JK,  et al.  Variation in post-TAVR antiplatelet therapy utilization and associated outcomes: insights from the STS/ACC TVT Registry.  Am Heart J. 2018;204:9-16. doi:10.1016/j.ahj.2018.06.006PubMedGoogle ScholarCrossref
62.
Honda  Y, Yamawaki  M, Araki  M,  et al; OCEAN-TAVI investigators.  Impact of HAS-BLED score to predict trans femoral transcatheter aortic valve replacement outcomes.  Catheter Cardiovasc Interv. 2018;92(7):1387-1396. doi:10.1002/ccd.27596PubMedGoogle ScholarCrossref
63.
Abdul-Jawad Altisent  O, Durand  E, Muñoz-García  AJ,  et al.  Warfarin and antiplatelet therapy versus warfarin alone for treating patients with atrial fibrillation undergoing transcatheter aortic valve replacement.  JACC Cardiovasc Interv. 2016;9(16):1706-1717. doi:10.1016/j.jcin.2016.06.025PubMedGoogle ScholarCrossref
64.
Seeger  J, Gonska  B, Rodewald  C, Rottbauer  W, Wöhrle  J.  Apixaban in patients with atrial fibrillation after transfemoral aortic valve replacement.  JACC Cardiovasc Interv. 2017;10(1):66-74. doi:10.1016/j.jcin.2016.10.023PubMedGoogle ScholarCrossref
65.
Geis  NA, Kiriakou  C, Chorianopoulos  E, Uhlmann  L, Katus  HA, Bekeredjian  R.  NOAC monotherapy in patients with concomitant indications for oral anticoagulation undergoing transcatheter aortic valve implantation.  Clin Res Cardiol. 2018;107(9):799-806. doi:10.1007/s00392-018-1247-xPubMedGoogle ScholarCrossref
66.
Jochheim  D, Barbanti  M, Capretti  G,  et al.  Oral anticoagulant type and outcomes after transcatheter aortic valve replacement.  JACC Cardiovasc Interv. 2019;12(16):1566-1576. doi:10.1016/j.jcin.2019.03.003PubMedGoogle ScholarCrossref
67.
Vora  AN, Dai  D, Matsuoka  R,  et al.  Incidence, management, and associated clinical outcomes of new-onset atrial fibrillation following transcatheter aortic valve replacement: an analysis from the STS/ACC TVT registry.  JACC Cardiovasc Interv. 2018;11(17):1746-1756. doi:10.1016/j.jcin.2018.05.042PubMedGoogle ScholarCrossref
68.
Ruile  P, Jander  N, Blanke  P,  et al.  Course of early subclinical leaflet thrombosis after transcatheter aortic valve implantation with or without oral anticoagulation.  Clin Res Cardiol. 2017;106(2):85-95. doi:10.1007/s00392-016-1052-3PubMedGoogle ScholarCrossref
69.
De Marchena  E, Mesa  J, Pomenti  S,  et al.  Thrombus formation following transcatheter aortic valve replacement.  JACC Cardiovasc Interv. 2015;8(5):728-739. doi:10.1016/j.jcin.2015.03.005PubMedGoogle ScholarCrossref
70.
Overtchouk  P, Guedeney  P, Rouanet  S,  et al.  Long-term mortality and early valve dysfunction according to anticoagulation use: the FRANCE TAVI registry.  J Am Coll Cardiol. 2019;73(1):13-21. doi:10.1016/j.jacc.2018.08.1045PubMedGoogle ScholarCrossref
71.
Cooper  T. Rivaroxaban (Xarelto): increase in all-cause mortality, thromboembolic and bleeding events in patients after transcatheter aortic valve replacement in a prematurely stopped clinical trial. https://www.hpra.ie/docs/default-source/default-document-library/important-safety-information—xarelto-(rivaroxaban)-(oct-2018).pdf?sfvrsn=0. Accessed September 3, 2019.
72.
Jimenez Diaz  VA, Tello-Montoliu  A, Moreno  R,  et al.  Assessment of platelet REACtivity after transcatheter aortic valve replacement: the REAC-TAVI trial.  JACC Cardiovasc Interv. 2019;12(1):22-32. doi:10.1016/j.jcin.2018.10.005PubMedGoogle ScholarCrossref
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