What is the relationship between anticoagulants (blood thinners) and aortic stenosis?

From the Guidelines

Anticoagulants are crucial in managing patients with aortic stenosis, particularly those with atrial fibrillation or a history of thromboembolic events.

Relationship between Anticoagulants and Aortic Stenosis

• The use of anticoagulants, such as vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs), is recommended for patients with aortic stenosis who have atrial fibrillation or a high risk of thromboembolic events 1.
• DOACs, including rivaroxaban, apixaban, and dabigatran, have been shown to be as effective and safe as VKAs in patients with valvular heart disease, including aortic stenosis 1.
• The decision to use anticoagulants in patients with aortic stenosis should be based on the individual patient's risk factors, such as the presence of atrial fibrillation, a history of thromboembolic events, and the severity of the aortic stenosis.

Specific Recommendations

• For patients with aortic stenosis and atrial fibrillation, anticoagulation with a VKA or DOAC is indicated, with a CHA2DS-VASc score of 2 or greater 1.
• DOACs can be used as an alternative to VKAs in patients with aortic stenosis and native valve disease, with a CHA2DS-VASc score of 2 or greater 1.

Important Considerations

• The use of anticoagulants in patients with aortic stenosis requires careful consideration of the individual patient's risk factors and the potential benefits and risks of anticoagulation.
• Regular monitoring of patients on anticoagulants is essential to minimize the risk of bleeding and other complications.
• The choice of anticoagulant should be based on the individual patient's characteristics, such as renal function, liver function, and the presence of other medical conditions.

From the Research

Anticoagulants and Aortic Stenosis

The relationship between anticoagulants (blood thinners) and aortic stenosis is complex and has been studied in various clinical trials.

• Anticoagulants are used to prevent thrombotic complications in patients with aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) or transcatheter aortic valve replacement (TAVR) 2, 3, 4, 5, 6.
• However, the use of anticoagulants also increases the risk of bleeding events, and the optimal antithrombotic regimen after TAVI or TAVR has yet to be determined 2, 3, 4, 5.

Clinical Outcomes

Studies have shown that:

• Direct oral anticoagulants (DOACs) are associated with a higher incidence of all-cause mortality, mortality due to non-cardiovascular causes, and the composite outcome of death, myocardial infarction, or stroke 3.
• DOACs are also associated with a decreased incidence of reduced leaflet motion (RLM) and hypoattenuated leaflet thickening (HALT) 3.
• Antiplatelet therapy with or without anticoagulant therapy is associated with a reduced risk of stroke in patients with prior atrial fibrillation undergoing TAVR 6.

Antithrombotic Regimens

Different antithrombotic regimens have been studied, including:

• Dual antiplatelet therapy (DAPT) with a combination of low-dose aspirin and clopidogrel for 3-6 months after TAVI or TAVR 4, 5.
• Single antiplatelet therapy, which may be safer than DAPT in patients without indications for oral anticoagulation 4.
• Oral anticoagulation monotherapy, which appears superior to anticoagulation plus antiplatelet therapy in patients where oral anticoagulant use is indicated 4.