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Page 10 of 13 Mauri et al. Mini-invasive Surg 2022;6:49 https://dx.doi.org/10.20517/2574-1225.2022.34

Figure 2. Central illustration: the best antithrombotic regimen in patients with or without indication to long-term oral anticoagulant
therapy. OAC: Oral anticoagulant; SAPT: single antiplatelet therapy; DAPT: dual antiplatelet therapy; VKA: vitamin K antagonist; CV:
cardiovascular; MI: myocardial infarction.

Several other randomized trials examining the safety and efficacy of various antithrombotic regimens are
ongoing. For instance, TICTAVI (NCT02817789) and PTOLEMAIOS (NCT02989558) are randomized
trials comparing ticagrelor (with or without aspirin) versus standard DAPT in TAVR patients.

Further data on valve thrombosis prevention will soon be available from the ongoing ADAPT-TAVR trial
(anticoagulant versus dual antiplatelet therapy for preventing leaflet thrombosis and cerebral embolization
after transcatheter aortic valve replacement) comparing edoxaban versus DAPT with aspirin and
clopidogrel for six-month incidence of leaflet thrombosis and cerebrovascular events in patients without
indication for OAC .
[45]
As a limitation of our effort, a critical approach of different treatments within each trial is lacking; however,
it appears very difficult to carry out, because all included patients have been stratified based on requirement
or not of long-term OAC.

In our opinion, future clinical trials should be focused on both baseline patients’ risk profiles (thrombotic
and hemorrhagic, as done for DAPT duration after coronary stent implantation) and specific procedural
settings, such as valve-in-valve.