Anticoagulation Management After Transcatheter and Surgical Valve Replacement

  • Ricardo Cigarroa
  • Sammy Elmariah
Valvular Heart Disease (J Dal-Bianco, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Valvular Heart Disease


Valvular heart disease is associated with high morbidity and mortality, and its prevalence is rising as the population ages. Treatment of severe valvular disease has historically required surgical correction, which carries its own risks, but there have been significant advances in valve replacement technologies and techniques, most notably the development of percutaneous options for repair and replacement. While valve replacements alleviate the hemodynamic burden of valvular disease, the synthetic material comprising part or all of the replacement valve provides nidus for clot, necessitating antithrombotic therapy. Providing the right balance between thromboembolic and bleeding risk is made more challenging by the comorbidities that often co-exist with valve disease in the elderly patient. The backbone of anticoagulation regimens has been comprised of aspirin, warfarin, or both, but newer agents are gaining popularity due to improved convenience and safety profiles. The expanding medical arsenal brings not only more options but also more complexity with the increasing number of possible combinations of anticoagulants and valve types. In general, mechanical heart valves are thought to be the most durable option with the highest thrombotic risk, requiring anticoagulation with warfarin with the addition of aspirin. Bioprosthetic valves placed surgically or percutaneously are less likely to cause thrombus and have been successfully managed with antiplatelet agents alone. However, concerns about previously undetected complications coming to light with new imaging techniques have brought uncertainty about current practice. In order to provide optimal care for our patients, careful review of the current literature, guideline recommendations, and the thrombotic and bleeding risk unique to the individual patient and valve type is necessary.


Valvular heart disease Valve replacement Mechanical heart valves Anticoagulation 


Compliance with Ethical Standards

Conflict of Interest

Ricardo Cigarroa declares no potential conflicts of interest. Sammy Elmariah reports a grant from Boehringer Ingelheim.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 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):1005–11.CrossRefPubMedGoogle Scholar
  2. 2.
    Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart disease and stroke Statistics-2016 update: a report from the American Heart Association. Circulation. 2016;133(4):e38–360.CrossRefPubMedGoogle Scholar
  3. 3.
    Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart disease and stroke Statistics-2017 update: a report from the American Heart Association. Circulation. 2017;135(10):e146–603.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Osnabrugge RL, Mylotte D, Head SJ, Van Mieghem NM, Nkomo VT, LeReun CM, et al. Aortic stenosis in the elderly: disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta-analysis and modeling study. J Am Coll Cardiol. 2013;62(11):1002–12.CrossRefPubMedGoogle Scholar
  5. 5.
    Pibarot P, Dumesnil JG. Prosthetic heart valves: selection of the optimal prosthesis and long-term management. Circulation. 2009;119:1034–48.CrossRefPubMedGoogle Scholar
  6. 6.
    Yoganathan AP, He Z, Casey Jones S. Fluid mechanics of heart valves. Annu Rev Biomed Eng. 2004;6:331–62.CrossRefPubMedGoogle Scholar
  7. 7.
    Cannegieter SC, Rosendaal FR, Briet E. Thromboembolic and bleeding complications in patients with mechanical heart valve prostheses. Circulation. 1994;89(2):635–41.CrossRefPubMedGoogle Scholar
  8. 8.
    Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Fleisher LA, 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):252–89.CrossRefPubMedGoogle Scholar
  9. 9.
    Yoon SH, Bleiziffer S, De Backer O, Delgado V, Arai T, Ziegelmueller J, et al. Outcomes in Transcatheter aortic valve replacement for bicuspid versus tricuspid aortic valve stenosis. J Am Coll Cardiol. 2017;69(21):2579–89.CrossRefPubMedGoogle Scholar
  10. 10.
    Bloomfield P, Wheatley DJ, Prescott RJ, Miller HC. Twelve-year comparison of a Bjork-Shiley mechanical heart valve with porcine bioprostheses. N Engl J Med. 1991;324(9):573–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Brennan JM, Edwards FH, Zhao Y, O'Brien S, Booth ME, Dokholyan RS, et al. Long-term safety and effectiveness of mechanical versus biologic aortic valve prostheses in older patients: results from the Society of Thoracic Surgeons adult cardiac surgery National Database. Circulation. 2013;127(16):1647–55.CrossRefPubMedGoogle Scholar
  12. 12.
    Smedira NG, Blackstone EH, Roselli EE, Laffey CC, Cosgrove DM. Are allografts the biologic valve of choice for aortic valve replacement in nonelderly patients? Comparison of explantation for structural valve deterioration of allograft and pericardial prostheses. J Thorac Cardiovasc Surg. 2006;131(3):558–64.e4.CrossRefPubMedGoogle Scholar
  13. 13.
    Brown JM, O'Brien SM, Wu C, Sikora JA, Griffith BP, Gammie JS. Isolated aortic valve replacement in North America comprising 108,687 patients in 10 years: changes in risks, valve types, and outcomes in the Society of Thoracic Surgeons National Database. J Thorac Cardiovasc Surg. 2009;137(1):82–90.CrossRefPubMedGoogle Scholar
  14. 14.
    Johnston DR, Soltesz EG, Vakil N, Rajeswaran J, Roselli EE, Sabik JF 3rd, et al. Long-term durability of bioprosthetic aortic valves: implications from 12,569 implants. Ann Thorac Surg. 2015;99(4):1239–47.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Chikwe J, Chiang YP, Egorova NN, Itagaki S, Adams DH. Survival and outcomes following bioprosthetic vs mechanical mitral valve replacement in patients aged 50 to 69 years. JAMA. 2015;313(14):1435–42.CrossRefPubMedGoogle Scholar
  16. 16.
    Chiang YP, Chikwe J, Moskowitz AJ, Itagaki S, Adams DH, Egorova NN. Survival and long-term outcomes following bioprosthetic vs mechanical aortic valve replacement in patients aged 50 to 69 years. JAMA. 2014;312(13):1323–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Gurvitch R, Cheung A, Ye J, Wood DA, Willson AB, Toggweiler S, et al. Transcatheter valve-in-valve implantation for failed surgical bioprosthetic valves. J Am Coll Cardiol. 2011;58(21):2196–209.CrossRefPubMedGoogle Scholar
  18. 18.
    Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Fleisher LA, 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. Circulation. 2017;135(25):e1159–95.CrossRefPubMedGoogle Scholar
  19. 19.
    Mok CK, Boey J, Wang R, Chan TK, Cheung KL, Lee PK, et al. Warfarin versus dipyridamole-aspirin and pentoxifylline-aspirin for the prevention of prosthetic heart valve thromboembolism: a prospective randomized clinical trial. Circulation. 1985;72(5):1059–63.CrossRefPubMedGoogle Scholar
  20. 20.
    Meschengieser SS, Fondevila CG, Frontroth J, Santarelli MT, Lazzari MA. Low-intensity oral anticoagulation plus low-dose aspirin versus high-intensity oral anticoagulation alone: a randomized trial in patients with mechanical prosthetic heart valves. J Thorac Cardiovasc Surg. 1997;113(5):910–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Turpie AG, Gent M, Laupacis A, Latour Y, Gunstensen J, Basile F, et al. A comparison of aspirin with placebo in patients treated with warfarin after heart-valve replacement. N Engl J Med. 1993;329(8):524–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Massel DR, Little SH. Antiplatelet and anticoagulation for patients with prosthetic heart valves. Cochrane Database Syst Rev. 2013(7):Cd003464.Google Scholar
  23. 23.
    Nishimura RA, Otto CM, Bonow RO, et al. 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 Practice Guidelines. J Thorac Cardiovasc Surg. 148:e1–e132Google Scholar
  24. 24.
    2017 ESC:EACTS Guidelines for the management of valvular heart diseas.pdf.Google Scholar
  25. 25.
    Torella M, Torella D, Chiodini P, Franciulli M, Romano G, De Santo L, et al. LOWERing the INtensity of oral anticoaGulant therapy in patients with bileaflet mechanical aortic valve replacement: results from the “LOWERING-IT” trial. Am Heart J. 2010;160(1):171–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Puskas J, Gerdisch M, Nichols D, Quinn R, Anderson C, Rhenman B, et al. Reduced anticoagulation after mechanical aortic valve replacement: interim results from the prospective randomized on-X valve anticoagulation clinical trial randomized Food and Drug Administration investigational device exemption trial. J Thorac Cardiovasc Surg. 2014;147(4):1202–10. discussion 10-1Google Scholar
  27. 27.
    Koertke H, Zittermann A, Tenderich G, Wagner O, El-Arousy M, Krian A, et al. Low-dose oral anticoagulation in patients with mechanical heart valve prostheses: final report from the early self-management anticoagulation trial II. Eur Heart J. 2007;28(20):2479–84.CrossRefPubMedGoogle Scholar
  28. 28.
    Heneghan C, Ward A, Perera R, Bankhead C, Fuller A, Stevens R, et al. Self-monitoring of oral anticoagulation: systematic review and meta-analysis of individual patient data. Lancet. 2012;379(9813):322–34.CrossRefPubMedGoogle Scholar
  29. 29.
    Koertke H, Zittermann A, Wagner O, Secer S, Christ of H, Sciangula A, et al. Telemedicine-guided, very low-dose international normalized ratio self-control in patients with mechanical heart valve implants. Eur Heart J. 2015;36(21):1297–305.CrossRefPubMedGoogle Scholar
  30. 30.
    Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. ESC/EACTS guidelines for the management of valvular heart disease: the task force for the management of Valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2017:2017.Google Scholar
  31. 31.
    Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, et al. 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 Practice Guidelines. J Thorac Cardiovasc Surg. 2014;148(1):e1–e132.CrossRefPubMedGoogle Scholar
  32. 32.
    Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361(12):1139–51.CrossRefPubMedGoogle Scholar
  33. 33.
    Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, et al. Rivaroxaban versus warfarin in Nonvalvular atrial fibrillation. N Engl J Med. 2011;365(10):883–91.CrossRefPubMedGoogle Scholar
  34. 34.
    Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365(11):981–92.CrossRefPubMedGoogle Scholar
  35. 35.
    Giugliano RP, Ruff CT, Braunwald E, Murphy SA, Wiviott SD, Halperin JL, et al. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2013;369(22):2093–104.CrossRefPubMedGoogle Scholar
  36. 36.
    Eikelboom JW, Connolly SJ, Brueckmann M, Granger CB, Kappetein AP, Mack MJ, et al. Dabigatran versus warfarin in patients with mechanical heart valves. N Engl J Med. 2013;369(13):1206–14.CrossRefPubMedGoogle Scholar
  37. 37.
    Cohn LH, Lambert JJ, Castaneda AR, Collins JJ Jr. Cardiac valve replacement with the stabilized glutaraldehyde porcine aortic valve: indications, operative results, and followup. Chest. 1975;68(2):162–5.CrossRefPubMedGoogle Scholar
  38. 38.
    Aramendi JI, Mestres CA, Martinez-Leon J, Campos V, Munoz G, Navas C. Triflusal versus oral anticoagulation for primary prevention of thromboembolism after bioprosthetic valve replacement (trac): prospective, randomized, co-operative trial. Eur J Cardiothorac Surg. 2005;27(5):854–60.CrossRefPubMedGoogle Scholar
  39. 39.
    Colli A, Mestres CA, Castella M, Gherli T. Comparing warfarin to aspirin (WoA) after aortic valve replacement with the St. Jude Medical epic heart valve bioprosthesis: results of the WoA epic pilot trial. J Heart Valve Dis. 2007;16(6):667–71.PubMedGoogle Scholar
  40. 40.
    ElBardissi AW, DiBardino DJ, Chen FY, Yamashita MH, Cohn LH. Is early antithrombotic therapy necessary in patients with bioprosthetic aortic valves in normal sinus rhythm? J Thorac Cardiovasc Surg. 2010;139(5):1137–45.CrossRefPubMedGoogle Scholar
  41. 41.
    Gherli T, Colli A, Fragnito C, Nicolini F, Borrello B, Saccani S, et al. Comparing warfarin with aspirin after biological aortic valve replacement: a prospective study. Circulation. 2004;110(5):496–500.CrossRefPubMedGoogle Scholar
  42. 42.
    Sundt TM, Zehr KJ, Dearani JA, Daly RC, Mullany CJ, McGregor CG, et al. Is early anticoagulation with warfarin necessary after bioprosthetic aortic valve replacement? J Thorac Cardiovasc Surg. 2005;129(5):1024–31.CrossRefPubMedGoogle Scholar
  43. 43.
    Nunez L, Gil Aguado M, Larrea JL, Celemin D, Oliver J. Prevention of thromboembolism using aspirin after mitral valve replacement with porcine bioprosthesis. Ann Thorac Surg. 1984;37(1):84–7.CrossRefPubMedGoogle Scholar
  44. 44.
    Goldsmith I, Lip GY, Mukundan S, Rosin MD. Experience with low-dose aspirin as thromboprophylaxis for the Tissuemed porcine aortic bioprosthesis: a survey of five years' experience. J Heart Valve Dis. 1998;7(5):574–9.PubMedGoogle Scholar
  45. 45.
    Brueck M, Kramer W, Vogt P, Steinert N, Roth P, Gorlach G, et al. Antiplatelet therapy early after bioprosthetic aortic valve replacement is unnecessary in patients without thromboembolic risk factors. Eur J Cardiothorac Surg. 2007;32(1):108–12.CrossRefPubMedGoogle Scholar
  46. 46.
    Riaz H, Alansari SAR, Khan MS, Riaz T, Raza S, Luni FK, et al. Safety and use of anticoagulation after aortic valve replacement with Bioprostheses. Circ Cardiovasc Qual Outcomes. 2016;9(3):294–302.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Masri A, Gillinov AM, Johnston DM, Sabik JF, Svensson LG, Rodriguez LL, et al. Anticoagulation versus antiplatelet or no therapy in patients undergoing bioprosthetic valve implantation: a systematic review and meta-analysis. Heart. 2017;103(1):40–8.CrossRefPubMedGoogle Scholar
  48. 48.
    Heras M, Chesebro JH, Fuster V, Penny WJ, Grill DE, Bailey KR, et al. High risk of thromboemboli early after bioprosthetic cardiac valve replacement. J Am Coll Cardiol. 1995;25(5):1111–9.CrossRefPubMedGoogle Scholar
  49. 49.
    Merie C, Kober L, Skov Olsen P, Andersson C, Gislason G, Skov Jensen J, et al. Association of warfarin therapy duration after bioprosthetic aortic valve replacement with risk of mortality, thromboembolic complications, and bleeding. JAMA. 2012;308(20):2118–25.CrossRefPubMedGoogle Scholar
  50. 50.
    Brennan JM, Edwards FH, Zhao Y, O'Brien S, Booth ME, Dokholyan RS, et al. Early anticoagulation of bioprosthetic aortic valves in older patients: results from the Society of Thoracic Surgeons adult cardiac surgery National Database. J Am Coll Cardiol. 2012;60(11):971–7.CrossRefPubMedGoogle Scholar
  51. 51.
    •• Makkar RR, Fontana G, Jilaihawi H, Chakravarty T, Kofoed KF, de Backer O, et al. Possible subclinical leaflet thrombosis in bioprosthetic aortic valves. N Engl J Med. 2015;373(21):2015–24. This study identified a high burden of subclinical leaflet thrombosis in both TAVR and SAVR bioprosthetic valves. This has spurred further investigation into identifying the benefit of routine coagulation after bioprosthetic valve replacements, and has already led some to change their practice.CrossRefPubMedGoogle Scholar
  52. 52.
    Chakravarty T, Sondergaard L, Friedman J, De Backer O, Berman D, Kofoed KF, et al. Subclinical leaflet thrombosis in surgical and transcatheter bioprosthetic aortic valves: an observational study. Lancet. 2017;389(10087):2383–92.CrossRefPubMedGoogle Scholar
  53. 53.
    Sondergaard L, De Backer O, Kofoed KF, Jilaihawi H, Fuchs A, Chakravarty T, et al. Natural history of subclinical leaflet thrombosis affecting motion in bioprosthetic aortic valves. Eur Heart J. 2017;38(28):2201–7.CrossRefPubMedGoogle Scholar
  54. 54.
    Egbe AC, Connolly HM, Pellikka PA, Schaff HV, Hanna R, Maleszewski JJ, et al. Outcomes of warfarin therapy for bioprosthetic valve thrombosis of surgically implanted valves: a prospective study. JACC Cardiovasc Interv. 2017;10(4):379–87.CrossRefPubMedGoogle Scholar
  55. 55.
    Del Trigo M, Munoz-Garcia AJ, Wijeysundera HC, Nombela-Franco L, Cheema AN, Gutierrez E, et al. Incidence, timing, and predictors of valve hemodynamic deterioration after transcatheter aortic valve replacement: multicenter registry. J Am Coll Cardiol. 2016;67(6):644–55.CrossRefPubMedGoogle Scholar
  56. 56.
    Egbe AC, Pislaru SV, Pellikka PA, Poterucha JT, Schaff HV, Maleszewski JJ, et al. Bioprosthetic valve thrombosis versus structural failure: clinical and echocardiographic predictors. J Am Coll Cardiol. 2015;66(21):2285–94.CrossRefPubMedGoogle Scholar
  57. 57.
    Yanagisawa R, Hayashida K, Jinzaki M, Fukuda K. Spontaneous regression of possible transcatheter aortic valve thrombosis without additional anticoagulant: two-year follow-up. J Invasive Cardiol. 2017;29(5):E64.PubMedGoogle Scholar
  58. 58.
    • Hafiz AM, Kalra A, Ramadan R, Poulin M-F, Andalib A, Phillips CT, et al. Clinical or symptomatic leaflet thrombosis following transcatheter aortic valve replacement: insights from the U.S. FDA MAUDE database. Struct Heart. 2017:1–9. This study found high morbidity associated with subclinical leaflet thrombosis in bioprosthetic valves, including stroke, cardiogenic shock and death. These findings have added gravity to the importance of identifying subclinical leaflet thrombosis and emphasize the need for further investigations into the benefit of routine anticoagulation in bioprosthetic valve replacements.Google Scholar
  59. 59.
    Jilaihawi H, Asch FM, Manasse E, Ruiz CE, Jelnin V, Kashif M, et al. Systematic CT methodology for the evaluation of subclinical leaflet thrombosis. JACC Cardiovascular Imaging. 2017;10(4):461–70.CrossRefPubMedGoogle Scholar
  60. 60.
    Carnicelli AP, De Caterina R, Halperin JL, Renda G, Ruff CT, Trevisan M, et al. Edoxaban for the prevention of thromboembolism in patients with atrial fibrillation and bioprosthetic valves. Circulation. 2017;135(13):1273–5.CrossRefPubMedGoogle Scholar
  61. 61.
    Grover FL, Vemulapalli S, Carroll JD, Edwards FH, Mack MJ, Thourani VH, et al. 2016 annual report of the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. J Am Coll Cardiol. 2017;69(10):1215–30.CrossRefPubMedGoogle Scholar
  62. 62.
    Holmes DR Jr, Brennan JM, Rumsfeld JS, Dai D, O’Brien SM, Vemulapalli S, et al. Clinical outcomes at 1 year following transcatheter aortic valve replacement. JAMA. 2015;313(10):1019–28.CrossRefPubMedGoogle Scholar
  63. 63.
    Muller DW, Farivar RS, Jansz P, Bae R, Walters D, Clarke A, et al. Transcatheter mitral valve replacement for patients with symptomatic mitral regurgitation: a global feasibility trial. J Am Coll Cardiol. 2017;69(4):381–91.CrossRefPubMedGoogle Scholar
  64. 64.
    Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363(17):1597–607.CrossRefPubMedGoogle Scholar
  65. 65.
    Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016;374(17):1609–20.CrossRefPubMedGoogle Scholar
  66. 66.
    Durand E, Blanchard D, Chassaing S, Gilard M, Laskar M, Borz B, et al. Comparison of two antiplatelet therapy strategies in patients undergoing transcatheter aortic valve implantation. Am J Cardiol. 2014;113(2):355–60.CrossRefPubMedGoogle Scholar
  67. 67.
    Hassell ME, Hildick-Smith D, Durand E, Kikkert WJ, Wiegerinck EM, Stabile E, et al. Antiplatelet therapy following transcatheter aortic valve implantation. Heart. 2015;101(14):1118–25.CrossRefPubMedGoogle Scholar
  68. 68.
    Rodes-Cabau J, Masson JB, Welsh RC, Garcia Del Blanco B, Pelletier M, Webb JG, 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):1357–65.CrossRefPubMedGoogle Scholar
  69. 69.
    Windecker S, Tijssen J, Giustino G, Guimaraes AH, Mehran R, Valgimigli M, et al. Trial design: rivaroxaban for the prevention of major cardiovascular events after transcatheter aortic valve replacement: rationale and design of the GALILEO study. Am Heart J. 2017;184:81–7.CrossRefPubMedGoogle Scholar
  70. 70.
    Sondergaard L, Sawaya FJ. Antithrombotic management after Transcatheter aortic valve replacement: More questions than answers. JACC Cardiovasc Interv. 2017;10(1):75–8.CrossRefPubMedGoogle Scholar
  71. 71.
    Yakubov SJ, Adams DH, Watson DR, Reardon MJ, Kleiman NS, Heimansohn D, et al. 2-year outcomes after Iliofemoral self-expanding transcatheter aortic valve replacement in patients with severe aortic stenosis deemed extreme risk for surgery. J Am Coll Cardiol. 2015;66(12):1327–34.CrossRefPubMedGoogle Scholar
  72. 72.
    Kodali SK, Williams MR, Smith CR, Svensson LG, Webb JG, Makkar RR, et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med. 2012;366(18):1686–95.CrossRefPubMedGoogle Scholar
  73. 73.
    Vavuranakis M, Kolokathis AM, Vrachatis DA, Kalogeras K, Magkoutis NA, Fradi S, et al. Atrial fibrillation during or after TAVI: incidence, implications and therapeutical considerations. Curr Pharm Des. 2016;22(13):1896–903.CrossRefPubMedGoogle Scholar
  74. 74.
    Genereux P, Cohen DJ, Mack M, Rodes-Cabau J, Yadav M, Xu K, et al. Incidence, predictors, and prognostic impact of late bleeding complications after transcatheter aortic valve replacement. J Am Coll Cardiol. 2014;64(24):2605–15.CrossRefPubMedGoogle Scholar
  75. 75.
    Dewilde WJ, Oirbans T, Verheugt FW, Kelder JC, De Smet BJ, Herrman JP, et al. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet. 2013;381(9872):1107–15.CrossRefPubMedGoogle Scholar
  76. 76.
    Abdul-Jawad Altisent O, Durand E, Munoz-Garcia AJ, Nombela-Franco L, Cheema A, Kefer J, 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):1706–17.CrossRefPubMedGoogle Scholar
  77. 77.
    Seeger J, Gonska B, Rodewald C, Rottbauer W, Wohrle J. Apixaban in patients with atrial fibrillation after transfemoral aortic valve replacement. JACC Cardiovasc Interv. 2017;10(1):66–74.CrossRefPubMedGoogle Scholar
  78. 78.
    Seeger J, Rottbauer W, Wohrle J. Reply: apixaban in patients with atrial fibrillation after transfemoral aortic valve replacement. JACC Cardiovasc Interv. 2017;10(9):965–6.CrossRefPubMedGoogle Scholar
  79. 79.
    McElhinney DB, Hellenbrand WE, Zahn EM, Jones TK, Cheatham JP, Lock JE, et al. Short- and medium-term outcomes after transcatheter pulmonary valve placement in the expanded multicenter US melody valve trial. Circulation. 2010;122(5):507–16.CrossRefPubMedPubMedCentralGoogle Scholar
  80. 80.
    Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. J Am Coll Cardiol. 2014;63(22):2438–88.CrossRefPubMedGoogle Scholar
  81. 81.
    Moinuddeen K, Quin J, Shaw R, Dewar M, Tellides G, Kopf G, et al. Anticoagulation is unnecessary after biological aortic valve replacement. Circulation. 1998;98(19 Suppl):II95–8. discussion II8–9Google Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Massachusetts General HospitalBostonUSA
  2. 2.Massachusetts General HospitalBostonUSA

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