From the Guidelines
The recommended duration of Plavix (clopidogrel) after Transcatheter Aortic Valve Replacement (TAVR) is typically 3-6 months, in combination with lifelong aspirin therapy, as supported by the most recent guidelines 1. The antiplatelet therapy regimen after TAVR is crucial in preventing thrombotic complications, including valve thrombosis and stroke, while allowing proper valve function and endothelialization.
- The current standard antithrombotic therapy after TAVR includes clopidogrel 75 mg orally daily for 3 to 6 months, along with oral aspirin 75 mg to 100 mg daily lifelong 1.
- For patients with chronic atrial fibrillation or other indications for long-term anticoagulation, anticoagulation should be continued as per guidelines, with the addition of aspirin 75-100 mg daily for 3-6 months after TAVR 1.
- The duration of dual antiplatelet therapy (DAPT) may be shortened to 1-3 months in patients with high bleeding risk, and the use of vitamin K antagonist therapy may be considered in certain cases 1.
- It is essential to weigh the benefits and risks of anticoagulant and antiplatelet therapy in each patient, considering factors such as bleeding risk, thrombotic risk, and individual patient characteristics 1.
From the Research
Recommended Antiplatelet Therapy Regimen After TAVR
The recommended antiplatelet therapy regimen for patients after Transcatheter Aortic Valve Replacement (TAVR) is a topic of ongoing research. Based on current studies, here are some key points to consider:
- The duration of dual antiplatelet therapy (DAPT) after TAVR is still being debated, with some studies suggesting that single antiplatelet therapy (SAPT) may be sufficient [ 2 ].
- A systematic review and network meta-analysis found that SAPT with aspirin had lower bleeding rates without increasing stroke or death compared to 3- or 6-month DAPT [ 2 ].
- Another study found that SAPT tended to reduce the occurrence of major adverse events following TAVR, with a lower rate of major or life-threatening bleeding events [ 3 ].
Comparison of Aspirin and Clopidogrel as Single Antithrombotic Therapy
Some studies have compared aspirin and clopidogrel as single antithrombotic therapy after TAVR:
- A study from the OCEAN-TAVI registry found that clopidogrel monotherapy was associated with a lower incidence of cardiovascular death compared to aspirin monotherapy during the 2-year follow-up after TAVR [ 4 ].
- However, another study found that DAPT with aspirin and clopidogrel reduced stroke recurrence and major adverse cardiovascular events, but increased the risk of moderate or severe bleeding [ 5 ].
Duration of Antiplatelet Therapy
The optimal duration of antiplatelet therapy after TAVR is still unclear:
- Some studies suggest that 3-6 months of DAPT may be sufficient [ 2 ].
- However, other studies have found that shorter durations of DAPT may be associated with similar outcomes [ 3 ].
- The decision on the duration of antiplatelet therapy should be individualized based on the patient's risk factors and clinical characteristics [ 6 ].