Management of antithrombotic therapy in patients undergoing transcatheter aortic valve implantation: a consensus document of the ESC Working Group on Thrombosis and the European Association of Percutaneous Cardiovascular Interventions (EAPCI), in collaboration with the ESC Council on Valvular Heart Disease.
Ten Berg, Jurrien; Sibbing, Dirk; Rocca, Biancaet al.
2021 • In European Heart Journal, 42 (23), p. 2265-2269
[en] Transcatheter aortic valve implantation (TAVI) is effective in older patients with symptomatic severe aortic stenosis, while the indication has recently broadened to younger patients at lower risk. Although thromboembolic and bleeding complications after TAVI have decreased over time, such adverse events are still common. The recommendations of the latest 2017 ESC/EACTS Guidelines for the management of valvular heart disease on antithrombotic therapy in patients undergoing TAVI are mostly based on expert opinion. Based on recent studies and randomized controlled trials, this viewpoint document provides updated therapeutic insights in antithrombotic treatment during and after TAVI.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Ten Berg, Jurrien ; Department of Cardiology and Center for Platelet Function Research, St Antonius ; The Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the
Sibbing, Dirk; Privatklinik Lauterbacher Mühle am Ostersee, Seeshaupt, Germany. ; Department of Cardiology, Ludwig-Maximilians-Universität München (LMU Munich), ; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart
Rocca, Bianca ; Institute of Pharmacology, Catholic University School of Medicine, Rome, Italy.
Van Belle, Eric; Department of Interventional Cardiology for Coronary, Valves and Structural Heart
Chevalier, Bernard; Ramsay Générale de Santé, ICPS, Hôpital Jacques Cartier, Massy, France.
Collet, Jean-Philippe ; ACTION Study Group, Institut De Cardiologie, Hôpital Pitié-Salpêtrière (APHP)
Dudek, Dariusz; Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland. ; Maria Cecilia Hospital, GVM Care&Research, Cotignola (RA), Italy.
Gilard, Martine; Department of Cardiology, La Cavale Blanche University Hospital Center,
Gorog, Diana A ; National Heart & Lung Institute, Imperial College, London, UK. ; Postgraduate Medical School, University of Hertfordshire, Hertfordshire, UK.
Grapsa, Julia ; Department of Cardiology, Guys and St Thomas NHS Hospitals, London, UK.
Grove, Erik Lerkevang ; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
LANCELLOTTI, Patrizio ; Centre Hospitalier Universitaire de Liège - CHU > > Service de cardiologie ; Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and
Petronio, Anna Sonia; Department of Cardiology, University of Pisa, Pisa, Italy.
Rubboli, Andrea; Department of Cardiovascular Diseases-AUSL Romagna, Division of Cardiology,
Torracca, Lucia; Department of Cardiac Surgery, Humanitas University Hospital Rozzano-Milano,
Vilahur, Gemma; Cardiovascular Program-ICCC, IR-Hospital de la Santa Creu i Sant Pau, CiberCV,
Witkowski, Adam; Department of Interventional Cardiology and Angiology, National Institute of
Mehilli, Julinda; Department of Cardiology, Ludwig-Maximilians-Universität München (LMU Munich), ; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart ; Department of Cardiology, Medizinische Klinik I, Landshut-Achdorf Hospital,
Management of antithrombotic therapy in patients undergoing transcatheter aortic valve implantation: a consensus document of the ESC Working Group on Thrombosis and the European Association of Percutaneous Cardiovascular Interventions (EAPCI), in collaboration with the ESC Council on Valvular Heart Disease.
Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Rodriguez Mu~noz D, Rosenhek R, Sjögren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL, ESC Scientific Document Group. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2017;38:2739-2791.
Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021;143:e72-e227.
Dangas GD, Tijssen JGP, Wö hrle J, Søndergaard L, Gilard M, Möllmann H, Makkar RR, Herrmann HC, Giustino G, Baldus S, De Backer O, Guimar~aes AHC, Gullestad L, Kini A, von Lewinski D, Mack M, Moreno R, Schäfer U, Seeger J, Tchétché D, Thomitzek K, Valgimigli M, Vranckx P, Welsh RC, Wildgoose P, Volkl AA, Zazula A, van Amsterdam RGM, Mehran R, Windecker S, GALILEO Investigators. A controlled trial of rivaroxaban after transcatheter aortic-valve replacement. N Engl J Med 2020;382:120-129.
Nijenhuis VJ, Brouwer J, Delewi R, Hermanides RS, Holvoet W, Dubois CLF, Frambach P, de Bruyne B, van Houwelingen GK, van der Heyden JAS, Tousek P, van der Kley F, Buysschaert I, Schotborgh CE, Ferdinande B, van der Harst P, Roosen J, Peper J, Thielen FWF, Veenstra L, Chan DRPP, Yin P, Swaans MJ, Rensing BJWM, van't Hof AWJ, Timmers L, Kelder JC, Stella PR, Baan J, Ten Berg JM. Anticoagulation with or without clopidogrel after transcatheter aortic-valve implantation. N Engl J Med 2020;382:1696-1707.
Brouwer J, Nijenhuis VJ, Delewi R, Hermanides RS, Holvoet W, Dubois CLF, Frambach P, De Bruyne B, van Houwelingen GK, Van Der Heyden JAS, Tousek P, van der Kley F, Buysschaert I, Schotborgh CE, Ferdinande B, van der Harst P, Roosen J, Peper J, Thielen FWF, Veenstra L, Chan Pin Yin DRPP, Swaans MJ, Rensing BJWM, van 't Hof AWJ, Timmers L, Kelder JC, Stella PR, Baan J, ten Berg JM. Aspirin with or without clopidogrel after transcatheter aortic-valve implantation. N Engl J Med 2020;383:1447-1457.
Nijenhuis VJ, ten Berg JM, Hengstenberg C, Lefevre T, Windecker S, Hildick-Smith D, Kupatt C, Van Belle E, Tron C, Hink HU, Colombo A, Claessen B, Sartori S, Chandrasekhar J, Mehran R, Anthopoulos P, Deliargyris EN, Dangas G. Usefulness of clopidogrel loading in patients who underwent transcatheter aortic valve implantation (from the BRAVO-3 randomized trial). Am J Cardiol 2019;123: 1494-1500.
Brinkert M, Mangner N, Moriyama N, Keller LS, Hagemeyer D, Crusius L, Lehnick D, Kobza R, Abdel-Wahab M, Laine M, Stortecky S, Pilgrim T, Nietlispach F, Ruschitzka F, Thiele H, Linke A, Toggweiler S. Safety and efficacy of transcatheter aortic valve replacement with continuation of vitamin k antagonists or direct oral anticoagulants. JACC Cardiovasc Interv 2021;14: 135-144.
Rodés-Cabau J, Masson JB, Welsh RC, Garcia Del Blanco B, Pelletier M, Webb JG, Al-Qoofi F, Généreux P, Maluenda G, Thoenes M, Paradis JM, Chamandi C, Serra V, Dumont E, Coté M. Aspirin versus aspirin plus clopidogrel as antithrombotic treatment following transcatheter aortic valve replacement with a balloonexpandable valve: the ARTE (Aspirin Versus Aspirin + Clopidogrel Following Transcatheter Aortic Valve Implantation) randomized clinical trial. JACC Cardiovasc Interv 2017;10:1357-1365.
Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La MM, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2021;42:375-498.
Butt JH, De Backer O, Olesen JB, Gerds TA, Havers-Borgersen E, Gislason GH, Torp-Pedersen C, Søndergaard L, Køber L, Fosbøl EL. Vitamin K antagonists vs. direct oral anticoagulants after transcatheter aortic valve implantation in atrial fibrillation. Eur Heart J Cardiovasc Pharmacother 2021;7:11-19.
Jochheim D, Barbanti M, Capretti G, Stefanini GG, Hapfelmeier A, Zadrozny M, Baquet M, Fischer J, Theiss H, Todaro D, Chieffo A, Presbitero P, Colombo A, Massberg S, Tamburino C, Mehilli J. Oral anticoagulant type and outcomes after transcatheter aortic valve replacement. JACC Cardiovasc Interv 2019;12: 1566-1576.
Abdul-Jawad Altisent O, Durand E, Mu~noz-Garciá AJ, Nombela-Franco L, Cheema A, Kefer J, Gutierrez E, Benítez LM, Amat-Santos IJ, Serra V, Eltchaninoff H, Alnasser SM, Elízaga J, Dager A, Garciá Del Blanco B, Ortas-Nadal MDR, Marsal JR, Campelo-Parada F, Regueiro A, Del Trigo M, Dumont E, Puri R, Rodés-Cabau J. Warfarin and antiplatelet therapy versus warfarin alone for treating patients with atrial fibrillation undergoing transcatheter aortic valve replacement. JACC Cardiovasc Interv 2016;9:1706-1717.
Valgimigli M, Bueno H, Byrne RA, Collet JP, Costa F, Jeppsson A, Jüni P, Kastrati A, Kolh P, Mauri L, Montalescot G, Neumann FJ, Petricevic M, Roffi M, Steg PG, Windecker S, Zamorano JL, Levine GN, 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;39:213-260.
De Backer O, Dangas GD, Jilaihawi H, Leipsic JA, Terkelsen CJ, Makkar R, Kini AS, Veien KT, Abdel-Wahab M, Kim WK, Balan P, Van Mieghem N, Mathiassen ON, Jeger RV, Arnold M, Mehran R, Guimar~aes AHC, Nørgaard BL, Kofoed KF, Blanke P, Windecker S, Søndergaard L, GALILEO-4D Investigators. Reduced leaflet motion after transcatheter aortic-valve replacement. N Engl J Med 2020;382: 130-139.
Makkar RR, Blanke P, Leipsic J, Thourani V, Chakravarty T, Brown D, Trento A, Guyton R, Babaliaros V, Williams M, Jilaihawi H, Kodali S, George I, Lu M, McCabe JM, Friedman J, Smalling R, Wong SC, Yazdani S, Bhatt DL, Bax J, Kapadia S, Herrmann HC, Mack M, Leon MB. Subclinical leaflet thrombosis in transcatheter and surgical bioprosthetic valves: PARTNER 3 cardiac computed tomography substudy. J Am Coll Cardiol 2020;75:3003-3015.
