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Mauri et al. Mini-invasive Surg 2022;6:49 https://dx.doi.org/10.20517/2574-1225.2022.34 Page 3 of 13

Table 1. Current recommendations of European and American guidelines for antithrombotic therapy after TAVR [1,5]
COR LOE
2021 ESC/EACTS Guidelines for the management of valvular heart disease
Oral anticoagulation is recommended lifelong for TAVR patients who have other indications for anticoagulation I B
Lifelong SAPT is recommended after TAVR in patients with no baseline indication for OAC I A
Routine use of OAC is not recommended after TAVR in patients with no baseline indication for OAC III B
2020 ACC/AHA Guideline for the Management of Patients with Valvular Heart Disease
For patients with a bioprosthetic TAVR, aspirin 75 to 100 mg daily is reasonable in the absence of other indications for oral 2a B-R
anticoagulants
For patients with a bioprosthetic TAVR who are at low risk of bleeding, dual antiplatelet therapy with aspirin 75 to 100 mg and 2b B-
clopidogrel 75 mg may be reasonable for 3 to 6 months after valve implantation NR
For patients with a bioprosthetic TAVR who are at low risk of bleeding, anticoagulation with a VKA to achieve an INR of 2.5 may be 2b B-
reasonable for at least 3 months after valve implantation NR
For patients with bioprosthetic TAVR, treatment with low-dose rivaroxaban (10 mg daily) plus aspirin (75-100 mg) is 3 B-R
contraindicated in the absence of other indications for oral anticoagulants

ESC: European Society of Cardiology; EACTS: European Association for Cardio-Thoracic Surgery; COR: class of recommendation; LOE: level of
evidence; ACC: American College of Cardiology; AHA: American Heart Association; R: randomized; NR: nonrandomized; VKA: vitamin K
antagonist; TAVR: transcatheter aortic valve replacement; OAC: oral anticoagulant therapy; SAPT: single antiplatelet therapy.

Figure 1. History of indications to TAVR: from prohibitive to low-intermediate risk.

related to patient risk factors such as age and comorbidities, mainly atrial fibrillation (AF) .
[7]

About half of patients undergoing TAVR present a concomitant coronary artery disease (CAD); however,
the rate of subsequent myocardial infarctions is low .
[9]