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Masiero et al. Mini-invasive Surg 2022;6:4 https://dx.doi.org/10.20517/2574-1225.2021.104 Page 13 of 19

Figure 5. TAVI procedural tricks according to anatomic considerations among women. FCA: Fluoroscopy guidance with contralateral
angiography; 2D-US: two-dimensional ultrasound.

Figure 6. Optimal antithrombotic regimen post-TAVI procedure. OAC: Oral anticoagulation; DAPT: dual antiplatelet therapy; ASA: acid
acetilsalicilic.

The 2021 ESC/EACTS guidelines recommend life-long single antiplatelet therapy or oral anticoagulation
(OAC) in the case of patients who have other indications for OAC, while dual antiplatelet therapy should be
administered only in the case of recent percutaneous coronary intervention . The 2020 ACC/AHA
[4]
guidelines recommend life-long low-dose aspirin post-TAVI (IIa), while aspirin plus clopidogrel or vitamin
[35]
K anticoagulation (VKA) for 3-6 months may be considered in patients with low bleeding risk (IIb) .
Cohort A of POPular TAVI randomized trial has recently shown a benefit in terms of incidence of bleeding
in patients without an OAC indication receiving aspirin alone vs. patients receiving aspirin plus clopidogrel
[risk ratio (RR) = 0.57; 95%CI: 0.42-0.77; P = 0.001], while the composite of cardiovascular death, stroke, or
myocardial infarction for aspirin alone was non-inferior to aspirin plus clopidogrel (9.7% and 9.9%, P =
[77]
0.004 for non-inferiority) . Among patients undergoing TAVI, 40% have an indication for OAC. This
subset of patients has been investigated in Cohort B of POPular TAVI trial, where a (novel) oral
anticoagulation (N)OAC alone strategy has been compared to a (N)OAC plus clopidogrel for three months.
Bleeding was significantly lower with (N)OAC alone vs. (N)OAC plus clopidogrel (21.7% vs. 34.6%; RR =
0.63; 95%CI: 0.43-0.90; P = 0.01), while the composite of cardiovascular death, stroke, or myocardial