Antithrombotic Therapy in Patients Undergoing Transcatheter Interventions for Structural Heart Disease

Paolo Calabrò; Felice Gragnano; Giampaolo Niccoli; Rossella Marcucci; Marco Zimarino; Carmen Spaccarotella; Giulia Renda; Giuseppe Patti; Giuseppe Andò; Elisabetta Moscarella; Massimo Mancone; Arturo Cesaro; Gennaro Giustino; Raffaele De Caterina; Roxana Mehran; Davide Capodanno; Marco Valgimigli; Stephan Windecker; George D. Dangas; Ciro Indolfi; Dominick J. Angiolillo

doi:10.1161/CIRCULATIONAHA.121.054305

Antithrombotic Therapy in Patients Undergoing Transcatheter Interventions for Structural Heart Disease

Paolo Calabrò, Felice Gragnano, Giampaolo Niccoli, Rossella Marcucci, Marco Zimarino, Carmen Spaccarotella, Giulia Renda, Giuseppe Patti, Giuseppe Andò, Elisabetta Moscarella, Massimo Mancone, Arturo Cesaro, Gennaro Giustino, Raffaele De Caterina, Roxana Mehran, Davide Capodanno, Marco Valgimigli, Stephan Windecker, George D. Dangas, Ciro IndolfiDominick J. Angiolillo

IRCCS Fondazione Policlinico Universitario A. Gemelli

Research output: Contribution to journal › Article › peer-review

Abstract

Contemporary evidence supports device-based transcatheter interventions for the management of patients with structural heart disease. These procedures, which include aortic valve implantation, mitral or tricuspid valve repair/implantation, left atrial appendage occlusion, and patent foramen ovale closure, profoundly differ with respect to clinical indications and procedural aspects. Yet, patients undergoing transcatheter cardiac interventions require antithrombotic therapy before, during, or after the procedure to prevent thromboembolic events. However, these therapies are associated with an increased risk of bleeding complications. To date, challenges and controversies exist regarding balancing the risk of thrombotic and bleeding complications in these patients such that the optimal antithrombotic regimens to adopt in each specific procedure is still unclear. In this review, we summarize current evidence on antithrombotic therapies for device-based transcatheter interventions targeting structural heart disease and emphasize the importance of a tailored approach in these patients.

Original language	English
Pages (from-to)	1323-1343
Number of pages	21
Journal	Circulation
Volume	144
Issue number	16
DOIs	https://doi.org/10.1161/CIRCULATIONAHA.121.054305
Publication status	Published - Oct 19 2021

Keywords

anticoagulants
atrial appendage
atrial fibrillation
foramen ovale, patent
mitral valve
thrombosis
transcatheter aortic valve replacement

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Physiology (medical)

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10.1161/CIRCULATIONAHA.121.054305

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Calabrò, P., Gragnano, F., Niccoli, G., Marcucci, R., Zimarino, M., Spaccarotella, C., Renda, G., Patti, G., Andò, G., Moscarella, E., Mancone, M., Cesaro, A., Giustino, G., De Caterina, R., Mehran, R., Capodanno, D., Valgimigli, M., Windecker, S., Dangas, G. D., ... Angiolillo, D. J. (2021). Antithrombotic Therapy in Patients Undergoing Transcatheter Interventions for Structural Heart Disease. Circulation, 144(16), 1323-1343. https://doi.org/10.1161/CIRCULATIONAHA.121.054305

Calabrò, P, Gragnano, F, Niccoli, G, Marcucci, R, Zimarino, M, Spaccarotella, C, Renda, G, Patti, G, Andò, G, Moscarella, E, Mancone, M, Cesaro, A, Giustino, G, De Caterina, R, Mehran, R, Capodanno, D, Valgimigli, M, Windecker, S, Dangas, GD, Indolfi, C & Angiolillo, DJ 2021, 'Antithrombotic Therapy in Patients Undergoing Transcatheter Interventions for Structural Heart Disease', Circulation, vol. 144, no. 16, pp. 1323-1343. https://doi.org/10.1161/CIRCULATIONAHA.121.054305

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AU - Mehran, Roxana

AU - Capodanno, Davide

AU - Valgimigli, Marco

AU - Windecker, Stephan

AU - Dangas, George D.

AU - Indolfi, Ciro

AU - Angiolillo, Dominick J.

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AB - Contemporary evidence supports device-based transcatheter interventions for the management of patients with structural heart disease. These procedures, which include aortic valve implantation, mitral or tricuspid valve repair/implantation, left atrial appendage occlusion, and patent foramen ovale closure, profoundly differ with respect to clinical indications and procedural aspects. Yet, patients undergoing transcatheter cardiac interventions require antithrombotic therapy before, during, or after the procedure to prevent thromboembolic events. However, these therapies are associated with an increased risk of bleeding complications. To date, challenges and controversies exist regarding balancing the risk of thrombotic and bleeding complications in these patients such that the optimal antithrombotic regimens to adopt in each specific procedure is still unclear. In this review, we summarize current evidence on antithrombotic therapies for device-based transcatheter interventions targeting structural heart disease and emphasize the importance of a tailored approach in these patients.

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Antithrombotic Therapy in Patients Undergoing Transcatheter Interventions for Structural Heart Disease

Abstract

Keywords

ASJC Scopus subject areas

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