Elsaygh Jude, Parikh Manish A, Frishman William H, Peterson Stephen J
From the Department of Medicine, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY.
Weill Department of Medicine, Weill Cornell Medicine, New York City, NY.
Cardiol Rev. 2025 May 13. doi: 10.1097/CRD.0000000000000908.
Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic stenosis, providing a less invasive alternative to surgical valve replacement. However, post-TAVR management remains complex, particularly concerning antithrombotic strategies, as patients face competing risks of bleeding and thrombosis. This review explores the evolving landscape of anticoagulation and antiplatelet therapy in TAVR patients, examining current American and European guidelines, clinical trial data, and the role of direct oral anticoagulants. We also highlight the interplay between atrial fibrillation, coronary artery disease, and antithrombotic therapy, emphasizing personalized approaches to patient management. Finally, we discuss complications such as stroke, subclinical leaflet thrombosis, and major bleeding, offering insights into mitigation strategies. As the field continues to evolve, ongoing research will shape future recommendations to optimize outcomes for patients undergoing TAVR.
经导管主动脉瓣置换术（TAVR）彻底改变了主动脉瓣狭窄的治疗方式，为外科瓣膜置换提供了一种侵入性较小的替代方法。然而，TAVR术后的管理仍然复杂，尤其是在抗栓策略方面，因为患者面临出血和血栓形成的相互竞争风险。本综述探讨了TAVR患者抗凝和抗血小板治疗的不断变化的格局，研究了当前美国和欧洲的指南、临床试验数据以及直接口服抗凝剂的作用。我们还强调了心房颤动、冠状动脉疾病和抗栓治疗之间的相互作用，强调个性化的患者管理方法。最后，我们讨论了中风、亚临床瓣叶血栓形成和大出血等并发症，并提供了缓解策略的见解。随着该领域的不断发展，正在进行的研究将塑造未来的建议，以优化接受TAVR患者的治疗效果。
