welcomes you to the new, improved website!Patients entered into a clinical trial of TAVR and patients in two registries were evaluated for possible subclinical leaflet thrombosis in their bioprosthetic valves. 40% of the patients in the TAVR trial and 13% of registry patients were found to have such thrombosis. The risk was lower in patients anticoagulated with warfarin. Therpeutic anticoagulation for thrombosis resulted in a high rate of resolution.The risk of TIA and stroke was somewhat increased in patients with thrombosis.
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Possible Subclinical Leaflet Thrombosis in Bioprosthetic Aortic Valves
Submitted by: Mark Ferguson
Source: New England Journal of Medicine
Keywords:
Author(s): Raj R. Makkar, Gregory Fontana, Hasan Jilaihawi, Tarun Chakravarty, Klaus F. Kofoed, Ole de Backer, Federico M. Asch, Carlos E. Ruiz, Niels T. Olsen, Alfredo Trento, John Friedman, Daniel Berman, Wen Cheng, Mohammad Kashif, Vladimir Jelnin, Chad A. Kliger, Hongfei Guo, Augusto D. Pichard, Neil J. Weissman, Samir Kapadia, Eric Manasse, Deepak L. Bhatt, Martin B. Leon, and Lars Søndergaard
1 Comment
This is an important article and an important message. Especially in the rapidly growing TAVI community subclinical and also clinically relevant leaflet thromboses are more common than currently reported and – out of own experience – oftentimes misinterpreted as leaflet dysfunction. Therapeutic anticoagulation may indeed resolve many of these thrombi, however early and correct diagnosis is mandatory. The problem is even more pronounced in patients with hemodynamic instability and low flow phases immediately after surgery on the intensive care unit and may even become lifethreatening in patients under extracorporeal life support, as reported earlier. Propably we need randomized trials to find out, whether a limited oral anticoagulation in the early postoperative phase, as performed in many centers after conventional implantation of a bioprosthesis, should also be recommended for TAVI´s instead of a dual antiplatelet therapy.