What Is the Optimal Antithrombotic Regimen After Transcatheter Aortic Valve Replacement?

In the first adequately powered, randomized trial to explore this question, rivaroxaban strikes out.

For patients undergoing transcatheter aortic valve replacement (TAVR), there is little guidance as to optimal antithrombotic therapy. Current guidelines recommend short-term dual antiplatelet therapy (DAPT; typically for 3–6 months), but this approach is derived from expert opinion. Given the high rate of thrombotic complications (including atrial fibrillation) and the recent recognition of subclinical leaflet thrombosis after TAVR, researchers examined whether an oral anticoagulant might improve outcomes.

In an industry-sponsored, open-label trial (GALILEO; NCT02556203), investigators randomized 1644 patients after successful TAVR and without indications for anticoagulation to a rivaroxaban-based regimen (rivaroxaban 10 mg/day indefinitely …

Reviewing Author

David J. Cohen, MD, MSc

Disclosures

Consultant/Advisory BoardMedtronic; Edwards Lifesciences; Abbott Vascular; Boston Scientific; St. Francis Hospital

Speaker’s BureauBoston Scientific; ZOLL Medical

Grant/Research SupportEdwards Lifesciences; Abbott Vascular; Boston Scientific; Corvia Medical; National Heart, Lung, and Blood Institute; Phillips, Inc.; St. Paul’s Hospital; V-Wave, Inc; ZOLL Medical; CathWorks, ANCORA

Editorial BoardsJACC; American Heart Journal; EuroIntervention; JSCAI; Structural Heart Journal

Leadership Positions in Professional SocietiesSociety of Thoracic Surgeons/American College of Cardiology TVT Registry (Co-Chair, Risk Model Development Committee); Cardiovascular Research Foundation (Co-Director, TCT Annual Meeting; Co-Director, New York Valves Annual Meeting)