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TAVR and DAPT: Are We Any Closer to the Answer?

Abstract:

The antiplatelet medication of choice for patients undergoing transcatheter aortic valve replacement (TAVR) has been derived empirically. Periprocedural stroke and adverse cardiac events have been associated with worse outcomes at 30 days and 1 year after TAVR, with half of these events occurring after 24 hours. 1-3 Dual antiplatelet therapy (DAPT), consisting of a thienopyridine and aspirin, improves clinical outcomes following coronary artery stenting through reductions in stent thrombosis and myocardial infarction. 4, 5 The mechanism of cardiac event rate reduction in coronary artery disease may be significantly different to that of TAVR. Platelet-mediated stent thrombosis, the antiproliferative effects of drug-eluting stents, and small caliber arteries are clearly a different milieu compared to TAVR procedures. The TAVR prosthesis has a greater metallic burden and greater flow turbulence across the valve, in …