Post-TAVR Medical Management
The recommended post-TAVR medical management includes lifelong aspirin 75-100 mg daily, clopidogrel 75 mg daily for 3-6 months, and coordinated follow-up care with the TAVR team, primary cardiologist, and primary care physician to optimize outcomes and reduce mortality. 1
Antithrombotic Therapy
- Aspirin 75-100 mg daily lifelong 1
- Clopidogrel 75 mg daily for 3-6 months 1
- Consider warfarin (INR 2.0-2.5) if patient is at risk of atrial fibrillation or venous thromboembolism 1
- Recent evidence suggests clopidogrel monotherapy may be associated with lower cardiovascular mortality compared to aspirin monotherapy during 2-year follow-up, regardless of anticoagulation use 2
Follow-up Schedule
- TAVR team evaluation at 30 days post-procedure 1
- Primary cardiologist follow-up at 6 months and then annually 1
- Primary care physician or geriatrician follow-up at 3 months and then as needed 1
- More frequent follow-up if there are changes in symptoms or transient conduction abnormalities 1
Diagnostic Monitoring
- Echocardiography at 30 days post-procedure and then annually as needed 1
- ECG at 30 days and annually 1
- Consider 24-hour ECG monitoring if bradycardia is present 1
- Monitor laboratory results including blood counts, metabolic panel, and renal function 1
- Assess pulmonary, renal, GI, and neurological function annually or as needed 1
Management of Comorbidities
- Optimize treatment of coronary artery disease 1
- Control hypertension 1
- Manage heart failure 1
- Treat arrhythmias, especially atrial fibrillation 1
Endocarditis Prevention
Special Considerations
- Early mobilization post-procedure is crucial, especially in elderly patients with multiple comorbidities 1
- Early discharge (within 72 hours) does not increase risk of 30-day mortality, bleeding, pacemaker implantation, or rehospitalization in selected patients undergoing transfemoral TAVR 1
- Bleeding risk assessment may be enhanced by evaluating closure time of adenosine diphosphate (CT-ADP), a marker of von Willebrand factor dysfunction 3
- Readmission rates exceed 40% in the first year after TAVR, most often due to non-cardiac causes 1
Long-term Valve Monitoring
- Regular assessment of prosthetic valve function is essential 1
- Be vigilant for signs of valve degeneration, which may occur years after the initial procedure 4
- Transcatheter valve-in-valve procedures may be considered for degenerated transcatheter valves in high-risk patients 4
- Surgical aortic valve replacement remains an option for failed TAVR valves in appropriate candidates 5