Table 2.
Current antithrombotic guideline recommendations for patients undergoing TAVI.
| American College of Cardiology/American Heart Association (AHA)/Society of Thoracic Surgeons [57,58] | European Society of Cardiology (ESC) [59] | American College of Chest Physicians [60] | |
|---|---|---|---|
| TAVI Post-Procedural | 75–100 mg aspirin OD indefinitely | Aspirin or clopidogrel indefinitely | 50–100 mg aspirin OD indefinitely (Grade 2C) |
| 75 mg clopidogrel OD for 6 months | Aspirin and clopidogrel early post-TAVI | 75 mg clopidogrel OD for 3 months (Grade 2C) | |
| If VKA indicated, no clopidogrel | If VKA indicated, no antiplatelet therapy | ||
| Bioprosthetic valves | |||
| Low risk | 75–100 mg aspirin OD (Class IIaB a) |
Low-dose aspirin (Class IIaC b) |
50–100 mg aspirin OD indefinitely (Grade 2C) |
| VKA (target INR 2.5) for at least 3 months (Class IIbB b) |
VKA (target INR 2.0–3.0) (Class IIbC c) |
||
| High risk | 75–100 mg aspirin OD (Class IIaB a) |
VKA (target INR 2.5) (Class IC a) |
|
| VKA (target INR 2.0–3.0) (Class I a) | |||
AHA risk factors: new-onset atrial fibrillation (AF), left ventricular dysfunction, previous thrombo-embolism, and hypercoagulable condition; ESC risk factors: AF, venous thrombo-embolism, hypercoagulable state, or with a lesser degree of evidence, severely impaired left ventricular dysfunction (ejection fraction ≤35%). OD: once daily; AF: atrial fibrillation; INR: international normalised ratio; TAVI: transcatheter aortic valve implantation; VKA: vitamin K antagonist. [14]. a Class I: conditions for which there is evidence for and/or general agreement that the procedure or treatment is beneficial, useful and effective. b Class IIa: weight of evidence/opinion is in favour of usefulness/efficacy. c Class IIb: usefulness/efficacy is less well established by evidence/opinion.