Heparin Drip is NOT a Priority After TAVR
No, a heparin drip is not a priority for post-TAVR management—in fact, anticoagulation is typically reversed immediately after the procedure, and the standard antithrombotic regimen consists of oral antiplatelet therapy, not intravenous heparin. 1
Immediate Post-TAVR Anticoagulation Management
The procedural approach is clear and contrary to starting systemic anticoagulation:
- Anticoagulation reversal is standard practice: Following TAVR deployment and removal of the delivery system, anticoagulation (typically unfractionated heparin used during the procedure) is reversed before access site closure 1
- No routine post-procedural heparin: The FDA labeling and clinical practice do not support routine continuation of heparin infusions after uncomplicated TAVR 2
- Immediate focus is hemostasis: Post-procedure priorities include monitoring the access site for bleeding, hematoma, or pseudoaneurysm formation—goals that are incompatible with therapeutic anticoagulation 1
Guideline-Recommended Antithrombotic Regimen
The American College of Cardiology provides explicit post-TAVR antithrombotic recommendations that do not include heparin:
- Aspirin 75-100 mg daily lifelong is the cornerstone of therapy 1
- Clopidogrel 75 mg daily for 3-6 months is added to aspirin as dual antiplatelet therapy 1, 3
- Oral anticoagulation (warfarin INR 2.0-2.5) should be considered only if the patient has atrial fibrillation or venous thromboembolism risk, but this is oral therapy, not intravenous heparin 1
When Heparin Might Be Considered (Rare Exceptions)
There are extremely limited circumstances where heparin could be used post-TAVR, but these are not routine:
- Only for specific complications: If there are angiographically visible dissections, mural thrombosis, or progressive neurological symptoms detected during or immediately after the procedure, heparin might be considered 4
- This is not standard practice: The evidence from over 4,800 real-world TAVR patients shows that the vast majority receive oral antiplatelet or anticoagulant therapy, not intravenous heparin 5
- Bleeding risk is paramount: Elderly TAVR patients have significantly elevated bleeding risk, and heparin infusions would substantially increase this risk without clear benefit 2, 6
Critical Pitfalls to Avoid
Understanding why heparin is inappropriate helps prevent serious complications:
- Do not extrapolate from other cardiac procedures: Unlike acute coronary syndromes or some other interventions where heparin bridges are used, TAVR has a fundamentally different risk-benefit profile 3, 7
- Elderly patients have higher bleeding risk: Patients over 60 years (the typical TAVR population) have higher plasma heparin levels, longer aPTTs, and increased bleeding complications with heparin 2
- Access site complications are common: Groin or thoracic access sites require careful hemostasis monitoring, which therapeutic anticoagulation would severely compromise 1
- Guideline non-adherence is already problematic: Real-world data shows 68% of TAVR patients receive non-guideline-concordant therapy, and adding heparin would worsen this deviation 5
The Correct Post-TAVR Priorities
Instead of heparin, focus on these evidence-based priorities:
- Resume pre-operative medications promptly including appropriate oral antithrombotics 1
- Monitor for bleeding and vascular complications at access sites 1
- Assess neurological status frequently for stroke detection 1
- Early mobilization as soon as access site hemostasis allows 1
- Initiate oral antiplatelet therapy (aspirin plus clopidogrel) if not already on board 1, 3
The evidence is unequivocal: therapeutic heparin infusions are not part of routine post-TAVR care and would increase bleeding risk in an already vulnerable elderly population without demonstrated benefit for preventing thrombotic complications.