Skip to main content
SpringerLink
Log in

Antithrombotic therapy before, during and after transcatheter aortic valve replacement (TAVR)

  • Published:
Journal of Thrombosis and Thrombolysis Aims and scope Submit manuscript

Abstract

Transcatheter aortic valve replacement (TAVR) has been emerged as a promising alternative for the management of patients with severe AS who otherwise are deemed inappropriate candidates for surgery. Post procedural thromboembolic events and risk of bleeding continue to be a significant challenge in managing patients who underwent TAVR. This article systematically reviews the evidence, current guidelines and upcoming studies investigating antithrombotic therapy before, during and after TAVR.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Carabello BA, Paulus WJ (2009) Aortic stenosis. Lancet 373(9667):956–966

    Article  PubMed  Google Scholar 

  2. Bonow RO, Carabello BA, Chatterjee K, de Leon AC Jr, Faxon DP, Freed MD et al.; for American College of Cardiology/American Heart Association Task Force on Practice Guidelines.(2008) 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 52(13):e1–142

  3. Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Baron-Esquivias G, Baumgartner H et al.(2013) Guidelines on the management of valvular heart disease (version 2012). The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). G Ital Cardiol (Rome).14(3):167–214

  4. Patrick PHu (2012) TAVR and SAVR: current treatment of aortic stenosis. Clin Med Insights Cardiol 6:125–139

    Google Scholar 

  5. Thomas M, Schymik G, Walther T, Himbert D, Lefèvre T, Treede H, Eggebrecht H, Rubino P, Michev I, Lange R, Anderson WN, Wendler O (2010) Thirty-day results of the SAPIEN aortic Bioprosthesis European Outcome (SOURCE) registry: a European registry of transcatheter aortic valve implantation using the Edwards SAPIEN valve. Circulation 122(1):62–69

    Article  PubMed  Google Scholar 

  6. Thomas M, Schymik G, Walther T, Himbert D, Lefèvre T, Treede H, Eggebrecht H, Rubino P, Colombo A, Lange R, Schwarz RR, Wendler O (2011) One-year outcomes of cohort 1 in the Edwards SAPIEN Aortic Bioprosthesis European Outcome (SOURCE) registry: the European registry of transcatheter aortic valve implantation using the Edwards SAPIEN valve. Circulation 124(4):425–433

    Article  PubMed  Google Scholar 

  7. Wendler O (2012) The multicenter SOURCE XT TAVR registry. Paper presented at EuroPCR 2012, Paris, France

  8. Tamburino C, Capodanno D, Ramondo A, Petronio AS, Ettori F, Santoro G et al (2011) Incidence and predictors of early and late mortality after transcatheter aortic valve implantation in 663 patients with severe aortic stenosis. Circulation 123(3):299–308

    Article  PubMed  Google Scholar 

  9. Bosmans JM, Kefer J, De Bruyne B, Herijgers P, Dubois C, Legrand V, Verheye S, Rodrigus I, Belgian TAVI Registry Participants (2011) Procedural, 30-day and one-year outcome following CoreValve or Edwards transcatheter aortic valve implantation: results of the Belgian national registry. Interact Cardiovasc Thorac Surg 12:762–767

    Article  PubMed  Google Scholar 

  10. Eltchaninoff H, Prat A, Gilard M, Leguerrier A, Blanchard D, Fournial G, Iung B, Donzeau-Gouge P, Tribouilloy C, Debrux JL, Pavie A, Gueret P, FRANCE Registry Investigators (2011) Transcatheter aortic valve implantation: early results of the FRANCE (French Aortic National CoreValve and Edwards) registry. Eur Heart J 32(2):191–197

    Article  PubMed  Google Scholar 

  11. Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG et al (2011) Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 364(23):2187–2198

    Article  CAS  PubMed  Google Scholar 

  12. Nuis RJ, Van Mieghem NM, Schultz CJ, Moelker A, van der Boon RM, van Geuns RJ (2012) Frequency and causes of stroke during or after transcatheter aortic valve implantation. Am J Cardiol 109(11):1637–1643

    Article  PubMed  Google Scholar 

  13. Ghanem A, Müller A, Nähle CP, Kocurek J, Werner N, Hammerstingl C, Schild HH, Schwab JO, Mellert F, Fimmers R, Nickenig G, Thomas D (2010) Risk and fate of cerebral embolism after transfemoral aortic valve implantation: a prospective pilot study with diffusion-weighted magnetic resonance imaging. J Am Coll Cardiol 55(14):1427–1432

    Article  PubMed  Google Scholar 

  14. Sharma A, Arbab-Zadeh A, Dubey D, Shani J, Lazar J, Frankel R (2013) Access site bleeding after transcatheter aortic valve implantation. J Thromb Thrombolysis 35(4):463–468

    Article  PubMed  Google Scholar 

  15. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG et al (2010) Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 363:1597–1607

    Article  CAS  PubMed  Google Scholar 

  16. Walther T, Kasimir MT, Doss M, Schuler G, Simon P, Schächinger V, Mohr FW, Wimmer-Greinecker G (2011) One-year interim follow-up results of the TRAVERCE trial: the initial feasibility study for trans-apical aortic-valve implantation. Eur J Cardiothorac Surg 39(4):532–537

    Article  PubMed  Google Scholar 

  17. Gilard M, Eltchaninoff H, Iung B, Donzeau-Gouge P, Chevreul K, Fajadet J et al (2012) Registry of transcatheter aortic-valve implantation in high-risk patients. N Engl J Med 366(18):1705–1715

    Article  CAS  PubMed  Google Scholar 

  18. Piazza N, Grube E, Gerckens U, den Heijer P, Linke A, Luha O et al (2008) Procedural and 30-day outcomes following transcatheter aortic valve implantation using the third generation (18 Fr) CoreValve ReValving system: results from the multicenter, expanded evaluation registry 1-year following CE mark approval. EuroIntervention 4(2):242–249

    Article  PubMed  Google Scholar 

  19. Moat NE, Ludman P, de Belder MA, Bridgewater B, Cunningham AD, Young CP et al (2011) Long-term outcomes after transcatheter aortic valve implantation in high-risk patients with severe aortic stenosis: the U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) registry. J Am Coll Cardiol 58(20):2130–2138

    Article  PubMed  Google Scholar 

  20. Zahn R, Gerckens U, Grube E, Linke A, Sievert H, Eggebrecht H, Hambrecht R, Sack S, Hauptmann KE, Richardt G, Figulla HR, Senges J, On behalf of theGerman Transcatheter Aortic Valve Interventions−Registry Investigators (2011) Transcatheter aortic valve implantation: first results from a multi-center real-world registry. Eur Heart J 32(2):198–204

    Article  PubMed  Google Scholar 

  21. Rodés-Cabau J, Webb JG, Cheung A, Ye J, Dumont E, Feindel CM et al (2010) Transcatheter aortic valve implantation for the treatment of severe symptomatic aortic stenosis in patients at very high or prohibitive surgical risk: acute and late outcomes of the multicenter Canadian experience. J Am Coll Cardiol 55(11):1080–1090

    Article  PubMed  Google Scholar 

  22. Linke A, Gerckens U, Wenaweser P, Tamburino C, Bosmans J, Brecker S, Bauernschmitt R (2012) Treatment of high risk aortic stenosis patients with transcatheter Medtronic CoreValve implantation: results from the international multicenter ADVANCE study. J Am Coll Cardiol 59(13s1):E8–E8

    Article  Google Scholar 

  23. Meredith I, Walton T, Walters D, Worthley S, Pasaputi S, Ormiston J, Whitbourn R, Yong G, Muller D (2012) TCT-806 Long-term outcomes from the core valve transcatheter aortic valve Australia–New Zealand study. J Am Coll Cardiol 60(17). doi:10.1016/j.jacc.2012.08.852

  24. Walters DL, Sinhal A, Baron D, Pasupati S, Thambar S, Yong G et al (2014) Initial experience with the balloon expandable Edwards-SAPIEN Transcatheter Heart Valve in Australia and New Zealand: the SOURCE ANZ registry: outcomes at 30 days and one year. Int J Cardiol 170(3):406–412

    Article  PubMed  Google Scholar 

  25. Abdel Wahab M, Mehilli J, Frerker C, Neumann FJ, Kurz T, Tölg R, Zachow D, Guerra E, Massberg S, Schäfer U, El-Mawardy M, Richardt G (2014) Comparison of balloon-expandable vs self-expandable valves in patients undergoing transcatheter aortic valve replacement: the CHOICE randomized clinical trial. JAMA 311(15):1503–1514

    Article  CAS  PubMed  Google Scholar 

  26. Mack MJ, Brennan JM, Brindis R, Carroll J, Edwards F, Grover F, Shahian D, Tuzcu EM, Peterson ED, Rumsfeld JS, Hewitt K, Shewan C, Michaels J, Christensen B, Christian A, O’Brien S, Holmes D; STS/ACC TVT Registry (2013) Outcomes following transcatheter aortic valve replacement in the United States. JAMA 310(19):2069–2077

    CAS  PubMed  Google Scholar 

  27. Fraccaro C, Al-Lamee R, Tarantini G, Maisano F, Napodano M, Montorfano M, Frigo AC, Iliceto S, Gerosa G, Isabella G, Colombo A (2012) Transcatheter aortic valve implantation in patients with severe left ventricular dysfunction: immediate and mid-term results, a multicenter study. Circ Cardiovasc Interv. 5(2):253–260

    Article  PubMed  Google Scholar 

  28. Harnek J, Freter W, Holm P, Ioanes D, James S, Nilsson J, Ruck A, Zagozdzon L (2012) TCT-902 report from the Swedish TAVI register: comparison of two valve types. J Am Coll Cardiol 60(17). doi:10.1016/j.jacc.2012.08.948

  29. Adams DH, Popma JJ, Reardon MJ, Yakubov SJ, Coselli JS, Deeb GM et al (2014) Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med 370(19):1790–1798

    Article  CAS  PubMed  Google Scholar 

  30. Drews T, Pasic M, Buz S, Unbehaun A, Dreysse S, Kukucka M, Mladenow A, Hetzer R (2011) Transcranial Doppler sound detection of cerebral microembolism during transapical aortic valve implantation. Thorac Cardiovasc Surg 59(4):237–242

    Article  CAS  PubMed  Google Scholar 

  31. Stortecky S, Windecker S, Pilgrim T, Heg D, Buellesfeld L, Khattab AA et al (2012) Cerebrovascular accidents complicating transcatheter aortic valve implantation: frequency, timing and impact on outcome. EuroIntervention. 8(1):62–70

    Article  PubMed  Google Scholar 

  32. Sun JC, Davidson MJ, Lamy A, Eikelboom JW (2009) Antithrombotic management of patients with prosthetic heart valves: current evidence and future trends. Lancet 374(9689):565–576

    Article  PubMed  Google Scholar 

  33. Steinlechner B, Zeidler P, Base E, Birkenberg B, Ankersmit HJ, Spannagl M, Quehenberger P, Hiesmayr M, Jilma B (2011) Patients with severe aortic valve stenosis and impaired platelet function benefit from preoperative desmopressin infusion. Ann Thorac Surg 91(5):1420–1426

    Article  PubMed  Google Scholar 

  34. Prohaska W, Zittermann A, Luth JU, Inoue K, Koster-Eiserfunke W, Baller D et al (2008) Prevalent platelet dysfunction in patients with aortic valve disease. J Heart Valve Dis 17(5):542–547

    PubMed  Google Scholar 

  35. Heras M, Chesebro JH, Fuster V, Penny WJ, Grill DE, Bailey KR et al (1995) High risk of thromboemboli early after bioprosthetic cardiac valve replacement. J Am Coll Cardiol 25(5):1111–1119

    Article  CAS  PubMed  Google Scholar 

  36. Amat-Santos IJ, Rodés-Cabau J, Urena M, DeLarochellière R, Doyle D, Bagur R, Villeneuve J, Côté M, Nombela-Franco L, Philippon F, Pibarot P, Dumont E (2012) Incidence, predictive factors, and prognostic value of new-onset atrial fibrillation following transcatheter aortic valve implantation. J Am Coll Cardiol 59(2):178–188

    Article  CAS  PubMed  Google Scholar 

  37. Holmes DR Jr, Mack MJ, Kaul S, Agnihotri A, Alexander KP, Bailey SR et al (2012) ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement. J Am Coll Cardiol 59(13):1200–1254

    Article  PubMed  Google Scholar 

  38. Fearn SJ, Parry AD, Picton AJ, Mortimer AJ, McCollum CN (1997) Should heparin be reversed after carotid endarterectomy? A randomised prospective trial(1997). Eur J Vasc Endovasc Surg 13(4):394–397

    Article  CAS  PubMed  Google Scholar 

  39. Levison JA, Faust GR, Halpern VJ, Theodoris A, Nathan I, Kline RG, Cohen JR (1999) Relationship of protamine dosing with postoperative complications of carotid endarterectomy. Ann Vasc Surg 13(1):67–72

    Article  CAS  PubMed  Google Scholar 

  40. Sergie Z, Lefèvre T, Van Belle E, Kakoulides S, Baber U, Deliargyris EN, Mehran R, Grube E, Reinöhl J, Dangas GD (2013) Current periprocedural anticoagulation in transcatheter aortic valve replacement: could bivalirudin be an option? Rationale and design of the BRAVO 2/3 studies. J Thromb Thrombolysis 35(4):483–493

    Article  CAS  PubMed  Google Scholar 

  41. Thompson KA, Philip KJ, Schwarz ER (2011) Clinical applications of bivalirudin in the cardiac catheterization laboratory. J Cardiovasc Pharmacol Ther 16(2):140–149

    Article  CAS  PubMed  Google Scholar 

  42. Abdel-Wahab M, Richardt G (2012) Safety of bivalirudin in patients with coronary artery disease. Expert Opin Drug Saf. 11(1):141–150

    Article  CAS  PubMed  Google Scholar 

  43. Noble S, Asgar A, Cartier R, Virmani R, Bonan R (2009) Anatomo-pathological analysis after CoreValve ReValving system implantation. EuroIntervention 5(1):78–85

    Article  PubMed  Google Scholar 

  44. Ussia GP, Scarabelli M, Mulè M, Barbanti M, Sarkar K, Cammalleri V et al (2011) Dual antiplatelet therapy versus aspirin alone in patients undergoing transcatheter aortic valve implantation. Am J Cardiol 108(12):1772–1776

    Article  CAS  PubMed  Google Scholar 

  45. Zeymer U, Zahn R, Gerckens U, Richardt G, Figulla HR, Senges J. (2011) Antithrombotic therapy after transfemoral aortic valve implantation (TAVI). Potential hazard of triple-therapy (abstr). Eur Heart J, 32(Suppl):900

  46. Dewilde W, Berg JT (2009) Design and rationale of the WOEST trial: what is the optimal antiplatelet and Anticoagulant therapy in patients with oral anticoagulation and coronary stenting (WOEST). Am Heart J 158(5):713–718

    Article  CAS  PubMed  Google Scholar 

  47. Rössig L, Genth-Zotz S, Rau M, Heyndrickx GR, Schneider T, Gulba DC, Desaga M, Buerke M, Harder S, Zeiher AM, ARG-E04 Study Group (2011) Argatroban for elective percutaneous coronary intervention: the ARG-E04 multi-center study. Int J Cardiol. 148(2):214–219

    Article  PubMed  Google Scholar 

  48. International, Multi-center, Open-label, Randomized Controlled Trial in Patients Undergoing TAVR to Determine the Treatment Effect (Both Safety and Efficacy) of Using Bivalirudin Instead of UFH (BRAVO 2/3). http://clinicaltrial.gov/ct2/show/NCT01651780. Accessed 24 June 2014

  49. Dual Antiplatelet Therapy Versus Oral Anticoagulation for a Short Time to Prevent Cerebral Embolism After TAVI (AUREA). http://clinicaltrials.gov/ct2/show/NCT01642134. Accessed 17 June 2014

  50. Aspirin Versus Aspirin & Clopidogrel Following Transcatheter Aortic Valve Implantation: The ARTE trial (2012) http://clinicaltrials.gov/ct2/show/nct01559298. Accessed 25 May 2014

  51. Intraprocedural Intraaortic Embolic Protection with the EmbolX Device in Patients Undergoing Transaortic Transcatheter Aortic Valve Implantation (TAo-EmbolX). https://clinicaltrials.gov/ct2/show/NCT01735513. Accessed 24 June 2014

  52. Maan A, Padmanabhan R, Shaikh AY, Mansour M, Ruskin JN, Heist EK (2012) Newer anticoagulants in cardiovascular disease: a systematic review of the literature. Cardiol Rev 20(5):209–221

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

All authors declare no conflict of interest.

Funding source

None.

Author information

Authors and Affiliations

  1. Division of Cardiovascular Medicine, State University of New York Downstate Medical Center, 1016, 50th Street, Apt 2C, Brooklyn, NY, 11219-9997, USA

    Abhishek Sharma & Jason Lazar

  2. Department of Medicine, Maimonides Medical Center, Brooklyn, NY, USA

    Sunny Goel

  3. Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA

    Carl J. Lavie

  4. Department of Preventive Medicine, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA

    Carl J. Lavie

  5. Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Armin Arbab-Zadeh

  6. Division of Cardiology, Texas Tech University, El Paso, TX, USA

    Debabrata Mukherjee

Authors
  1. Abhishek Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sunny Goel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carl J. Lavie
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Armin Arbab-Zadeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Debabrata Mukherjee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jason Lazar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Abhishek Sharma.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sharma, A., Goel, S., Lavie, C.J. et al. Antithrombotic therapy before, during and after transcatheter aortic valve replacement (TAVR). J Thromb Thrombolysis 39, 467–473 (2015). https://doi.org/10.1007/s11239-014-1118-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11239-014-1118-x

Keywords

Search

Navigation