Antithrombotic Therapy Following Structural Heart Disease Interventions: Current Status and Future Directions

Abstract

Interventions in structural heart disease cover many catheter-based procedures for congenital and acquired conditions including valvular diseases, septal defects, arterial or venous obstructions, and fistulas. Among the available procedures, the most common are aortic valve implantation, mitral or tricuspid valve repair/implantation, left atrial appendage occlusion, and patent foramen ovale closure. Antithrombotic therapy for transcatheter structural heart disease interventions aims to prevent thromboembolic events and reduce the risk of short-term and long-term complications. The specific approach to antithrombotic therapy depends on the type of intervention and individual patient factors. In this review, we synopsize contemporary evidence on antithrombotic therapies for structural heart disease interventions and highlight the importance of a personalized approach. These recommendations may evolve over time as new evidence emerges and clinical guidelines are updated. Therefore, it's crucial for healthcare professionals to stay updated on the most recent guidelines and individualize therapy based on patient-specific factors and procedural considerations.

Keywords: ASD; LAA; TAVI; TEER; TMVR; antiplatelets; antithrombotics; atrial appendage; atrial fibrillation; mitral valve; patent foramen ovale; transcatheter aortic valve implantation.

Fig. 1.

Illustration of virchow’s triad in device-related thrombosis. The figure depicts the three key factors—endothelial injury, altered blood flow, and hypercoagulability—comprising Virchow’s Triad, contributing to thrombosis formation on the device surface.

Fig. 2.

Schematic representation of contact activation on artificial surface leading to device thrombosis. The figure illustrates the stepwise process by which contact activation occurs on the artificial surface, ultimately resulting in thrombosis of the device.