Antithrombotic management after transcatheter aortic valve implantation: Evolving evidence and simplified strategies in the 2025 European Society of Cardiology era

Transcatheter aortic valve implantation (TAVI) has revolutionised the treatment of severe aortic stenosis, exten ding from inoperable patients to those at low surgical risk. Yet thromboembolic and bleeding events remain major determinants of outcomes. Antithrombotic management after TAVI is complex because of competing ischemic and haemorrhagic risks in elderly, comorbid patients. Over the past decade, randomised evidence and large registries have progressively shifted the paradigm toward treatment simplification. Current recommendations now favour aspirin monotherapy for patients without an indication for long-term oral anticoagulation (OAC), and OAC monotherapy for those requiring anticoagulation, reserving dual antiplatelet therapy (DAPT) only for selected cases such as recent percutaneous coronary intervention. Subclinical leaflet thrombosis, a frequent but often transient phenomenon, remains of uncertain clinical significance. This review integrates current evidence with real-world insights, mechanistic data, and evolving concepts that underpin the contemporary, individualised approach to post-TAVI antithrombotic therapy.