While transcatheter aortic valve implantation (TAVI) has rapidly evolved as an acceptable alternative to
conventional surgical aortic valve replacement in elderly, high-risk surgical candidates with critical aortic stenosis,
thrombotic and bleeding complications remain relatively frequent and potentially life-threatening. Thrombotic
events during and following TAVI relate to the dynamic interplay between the systemic burden of atherosclerotic
disease, atrial arrhythmias, device and native aortic valve interactions, as well as platelet and coagulation cascade
activation. Bleeding in the acute setting relates primarily to access site vascular complications, but also appears related
to pre-existing renal impairment and anemia. Current pre-, peri- and post-procedural anti-thrombotic regimens
are empirical, based on expert consensus following extrapolation from the wealth of experience gleaned following
percutaneous coronary intervention. However the complexities of the TAVI procedure, the high-risk clinical substrate and competing
effects of anti-thrombotic regimens and bleeding risk are yet to be prospectively assessed in randomized clinical trials for defining
evidence-based anti-thrombotic strategies.
Keywords: TAVI, bleeding, thromobosis, DAPT, warfarin.
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