The ongoing dilemma of anticoagulation after TAVI: Seek quality evidence.

Since its introduction 20 years ago [ [1] Cribier A. Eltchaninoff H. Bash A. Borenstein N. Tron C. Bauer F. et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation. 2002 Dec; 106 (PMID:12473543): 3006-3008https://doi.org/10.1161/01.CIR.0000047200.36165.B8 Crossref PubMed Scopus (2640) Google Scholar ], transcatheter aortic valve implantation (TAVI) has revolutionized the field of cardiology and has become the therapy of choice for the majority of patients with severe aortic stenosis over the age of 70 years [ [2] Mack M.J. Leon M.B. Thourani V.H. Makkar R. Kodali S.K. Russo M. et al. PARTNER 3 Investigators. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N. Engl. J. Med. 2019 May; 380 (PMID:30883058): 1695-1705https://doi.org/10.1056/NEJMoa1814052 Crossref PubMed Scopus (2695) Google Scholar , [3] Popma J.J. Deeb G.M. Yakubov S.J. Mumtaz M. Gada H. O’Hair D. et al. Evolut Low Risk Trial Investigators. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N. Engl. J. Med. 2019 May; 380: 1706-1715https://doi.org/10.1056/NEJMoa1816885PMID:30883053 Crossref PubMed Scopus (0) Google Scholar , [4] Gupta T. Kolte D. Khera S. Goel K. Villablanca P.A. Kalra A. et al. Collaborators. The changing landscape of aortic valve replacement in the USA. EuroIntervention. 2019 Dec; 15 (PMID:31403460): e968-e974https://doi.org/10.4244/EIJ-D-19-00381 Crossref PubMed Scopus (10) Google Scholar ]. Despite the abundance of large clinical trials focused on TAVI devices, many issues related to the best pharmacological regimen after a successful TAVI remain unanswered, including the role of non-vitamin K oral anticoagulants (NOACs). Direct oral anticoagulants or vitamin K antagonists after TAVR: A systematic review and meta-analysisInternational Journal of CardiologyVol. 365PreviewSeveral patients undergoing transcatheter aortic valve replacement (TAVR) also require oral anticoagulation (OAC) for atrial fibrillation (AF) or deep vein thromboembolism. However, the optimal type of OAC strategy (direct oral anticoagulants, DOACs, or vitamin K antagonists, VKA) is still unclear in this setting. Full-Text PDF