Defining optimal antithrombotic therapy post-TAVI: the contribution of ATLANTIS

What is the best antithrombotic regimen for patients undergoing transcatheter aortic valve implantation (TAVI)? Recent randomized controlled trials (RCTs) have shown reduced bleeding risk with aspirin, compared to aspirin plus clopidogrel, for TAVI patients with no indication for oral anticoagulation (OAC), and with OAC alone, compared to OAC plus clopidogrel, for TAVI patients requiring OAC mostly because of atrial fibrillation (AF).1,2 Not adding clopidogrel to aspirin or OAC did not appear to enhance thrombo-embolic risk. Although the trials were underpowered for endpoints such as stroke and myocardial infarction (MI), lifelong monotherapy post-TAVI with an antiplatelet or an anticoagulant agent (if indicated) has a class I recommendation in current guidelines.

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