When Direct Oral Anticoagulants Should Not Be Standard Treatment

Journal of the American College of Cardiology, Journal Year: 2024, Volume and Issue: 83(3), P. 444 - 465

Published: Jan. 1, 2024

Language: Английский

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Bleeding Events After Transcatheter Aortic Valve Replacement

Journal of the American College of Cardiology, Journal Year: 2023, Volume and Issue: 81(7), P. 684 - 702

Published: Feb. 1, 2023

Language: Английский

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Antithrombotic Therapy in High Bleeding Risk, Part I

КАРДИОЛОГИЯ УЗБЕКИСТАНА, Journal Year: 2024, Volume and Issue: 17(19), P. 2197 - 2215

Published: Oct. 1, 2024

Language: Английский

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Valve Thrombosis Following Transcatheter Aortic Valve Replacement: State‐of‐the‐Art Review

Catheterization and Cardiovascular Interventions, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 5, 2025

Transcatheter aortic valve replacement (TAVR) is a well-established treatment for severe stenosis, especially in patients over 75 or those at high surgical risk. While these prosthetic valves have lower thrombogenic profile than mechanical heart valves, leaflet thrombosis transcatheter (TAV) occurs an estimated 5%-40% of cases. Most TAV thromboses are subclinical and can be detected via cardiac computed tomography (CCT), which reveals hypo-attenuating thickening reduced motion asymptomatic without elevated transprosthetic gradients on echocardiography. The mechanisms behind involve local triggers, patient predisposing factors, device procedure-related aspects. ideal antithrombotic therapy post-TAVR depends individual characteristics, balancing bleeding risks with the need oral anticoagulants. Data optimal management routine use CT limited. anticoagulation effectively resolves clinically significant prosthesis thrombosis, its benefit cases unclear. There ongoing debate about whether precedes clinical making follow-up after implantation uncertain. This article aims to provide comprehensive review, summarizing current data incidence TAVR underlying mechanisms, imaging diagnosis, strategies, preventive measures, long-term follow-up.

Language: Английский

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Acute, periprocedural and longterm antithrombotic therapy in older adults

European Heart Journal, Journal Year: 2022, Volume and Issue: 44(4), P. 262 - 279

Published: Sept. 8, 2022

The first international guidance on antithrombotic therapy in the elderly came from European Society of Cardiology Working Group Thrombosis 2015. This same group has updated its previous report antiplatelet and anticoagulant drugs for older patients with acute or chronic coronary syndromes, atrial fibrillation, undergoing surgery procedures typical (transcatheter aortic valve implantation left appendage closure). aim is to provide a succinct but comprehensive tool readers understand bases patients, despite complexities comorbidities, comedications uncertain ischaemic- vs. bleeding-risk balance. Fourteen consensus statements integrate recent trial data other evidence, focus high bleeding risk. Guideline recommendations, when present, are highlighted, as well gaps evidence. Key points include efforts improve medical adherence through deprescribing polypill use; adoption universal risk definitions bleeding, myocardial infarction, stroke cause-specific death; multiple bleeding-avoidance strategies, ranging gastroprotection aspirin use selection antithrombotic-drug composition, dosing duration tailored variables (setting, history, overall risk, age, weight, renal function, comedications, procedures) that need special consideration managing adults.

Language: Английский

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A 20-year journey in transcatheter aortic valve implantation: Evolution to current eminence

Frontiers in Cardiovascular Medicine, Journal Year: 2022, Volume and Issue: 9

Published: Nov. 21, 2022

Since the first groundbreaking procedure in 2002, transcatheter aortic valve implantation (TAVI) has revolutionized management of stenosis (AS). Through striking developments pertinent equipment and techniques, TAVI now become leading therapeutic strategy for replacement patients with severe symptomatic AS. The streamlining from routine use conscious sedation to a single arterial access approach, newly adapted introduction novel technologies such as intravascular lithotripsy refinement valve-bioprosthesis devices along accumulating experience have resulted dramatic reduction complications improved associated outcomes that are considered comparable or even superior surgical (SAVR). These advances opened road younger lower-risk up-to-date data landmark studies established outstanding efficacy safety low-surgical risk impelling most recent ESC guidelines propose TAVI, main AS aged 75 years older. In this article, we aim summarize current clinical aspects involving also attempt highlight impending concerns need be further addressed.

Language: Английский

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Efficacy and outcomes of antiplatelet therapy versus oral anticoagulants in patients undergoing transcatheter aortic valve replacement: a systematic review and meta-analysis

Annals of Medicine and Surgery, Journal Year: 2024, Volume and Issue: unknown

Published: March 14, 2024

Recent guidelines suggest that antiplatelet therapy (APT) is the standard of care in absence long-term oral anticoagulation (OAC) indications patients post-transcatheter aortic valve replacement (TAVR). The superiority one method over other remains controversial.

Language: Английский

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Effect of Evogliptin on the Progression of Aortic Valvular Calcification

Journal of the American College of Cardiology, Journal Year: 2024, Volume and Issue: 84(12), P. 1064 - 1075

Published: Sept. 1, 2024

Language: Английский

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Early Detection of Risk of Neo-Sinus Blood Stasis Post-Transcatheter Aortic Valve Replacement Using Personalized Hemodynamic Analysis

Structural Heart, Journal Year: 2023, Volume and Issue: 7(5), P. 100180 - 100180

Published: April 28, 2023

Despite the demonstrated benefits of transcatheter aortic valve replacement (TAVR), subclinical leaflet thrombosis and hypoattenuated thickening are commonly seen as initial indications decreased durability augmented risk transient ischemic attack.We developed a multiscale patient-specific computational framework to quantify metrics global circulatory function, cardiac local fluid dynamics root coronary arteries.Based on our findings, TAVR might be associated with high blood stagnation in neo-sinus region due lack sufficient flow washout during diastole phase (e.g., maximum stasis volume increased by 13, 8, 2.7 fold left cusp, right noncoronary respectively [N = 26]). Moreover, some patients, not ventricle load relief reduced only 1.2 % 26]) diastolic improvement 4.94%, 15.05%, 23.59% anterior descending, circumflex artery, respectively, 26]).The transvalvular pressure gradient amelioration after translate into adequate sinus washout, optimal flow, stress. Noninvasive personalized modeling can facilitate determination most effective revascularization strategy pre-TAVR monitor plaque progression post-TAVR.

Language: Английский

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Antithrombotic therapy and cardiovascular outcomes after transcatheter aortic valve implantation in patients without indications for chronic oral anticoagulation: a systematic review and network meta-analysis of randomized controlled trials

European Heart Journal - Cardiovascular Pharmacotherapy, Journal Year: 2023, Volume and Issue: 9(3), P. 251 - 261

Published: Jan. 14, 2023

Abstract Aims As the antithrombotic regimen that may best prevent ischaemic complications along with lowest bleeding risk offset following transcatheter aortic valve implantation (TAVI) remains unclear, we aimed to compare safety and efficacy of regimens in patients without having an indication for chronic oral anticoagulation. Methods results We conducted a PROSPERO-registered (CRD42021247924) systematic review network meta-analysis randomized controlled trials evaluating post-TAVI up April 2022. estimated relative (RR) 95% confidence intervals (95% CIs) using random-effects model frequentist pairwise metanalytic approach. included seven studies comprising 4006 mean weighted follow-up 12.9 months. Risk all-cause death was significantly reduced dual antiplatelet therapy (DAPT) compared low-dose rivaroxaban + 3-month single (SAPT) (RR 0.60, CI 0.41–0.88), while no significant reduction observed SAPT vs. DAPT 1.02, 0.67–1.58) apixaban or edoxaban 0.32–1.14 RR 0.59, 0.34–1.02, respectively). associated life-threatening, disabling, major 0.45, 0.29–0.70), alone 0.25–0.79), 0.30, 0.16–0.57). There were differences between various respect myocardial infarction, stroke, systemic embolism. Conclusion Following TAVI anticoagulant, more than halved direct anticoagulant-based offset.

Language: Английский

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