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Seyed Mohsen Jahromi Moghadam: Antithrombotic Therapy After Transcatheter Structural Heart Interventions
Seyed Mohsen Jahromi Moghadam/LinkedIn
Feb 2, 2026, 16:48

Seyed Mohsen Jahromi Moghadam: Antithrombotic Therapy After Transcatheter Structural Heart Interventions

Seyed Mohsen Jahromi Moghadam, Advanced Interventional Cardiologist at Razavi Hospital, posted on LinkedIn:

”After transcatheter structural heart interventions, antithrombotic therapy must balance prevention of device-related thrombosis (DRT) against bleeding risk. Evidence is strongest for TAVI; for other procedures, data are limited and treatment should be individualized.

1) Transcatheter Aortic Valve Implantation (TAVI)

Patients without an indication for oral anticoagulation (OAC):
• Lifelong single antiplatelet therapy (SAPT), usually low-dose aspirin, is recommended.
• Dual antiplatelet therapy (DAPT) increases bleeding without ischemic benefit.
• Routine DOAC use is discouraged due to higher mortality and bleeding despite reducing subclinical leaflet thrombosis (SLT).

Subclinical leaflet thrombosis (HALT/RLM):
• More frequent with antiplatelet therapy than with OAC.
• Associated with higher stroke/TIA risk.
• Temporary OAC (VKA or DOAC) for ~3–6 months is recommended when SLT is detected, with CT follow-up.

Patients with an indication for chronic OAC (e.g., atrial fibrillation):
• OAC alone is preferred.
• Adding antiplatelet therapy increases bleeding without benefit.
• DOACs appear reasonable alternatives to VKAs if appropriately dosed and without routine antiplatelet use.

2) Mitral and Tricuspid Interventions
• Valve replacement (TMVI/TTVI): High risk of DRT → OAC for at least 3 months is generally recommended.
• Edge-to-edge repair (TEER): DRT is rare; resume OAC if indicated or use short-term SAPT.
• Evidence comparing DOACs vs VKAs is limited, but DOACs may reduce bleeding.

3) Patent Foramen Ovale (PFO) / Atrial Septal Defect (ASD) Closure
• Traditional approach: DAPT for 1–6 months, then SAPT.
• Recent observational data suggest no clear advantage of DAPT over SAPT.
• In selected low-risk patients, complete discontinuation of antithrombotic therapy after endothelialization may be safe, but evidence is still evolving.

4) Left Atrial Appendage Occlusion (LAAO)
• DRT occurs in <5%, mostly within the first 90 days, but markedly increases stroke risk.
• Regimens vary:
• Short-term OAC or DAPT followed by SAPT is common.
• Emerging evidence suggests low-dose or half-dose DOAC monotherapy may reduce both DRT and bleeding in high-bleeding-risk patients.
• Optimal regimen remains under investigation in ongoing RCTs.

Conclusion
• Antithrombotic strategies after transcatheter structural heart interventions must be procedure-specific and patient-tailored.
• Overly aggressive therapy increases bleeding, while insufficient therapy increases thrombotic risk.
• Future trials (including imaging-guided and factor XIa inhibitor strategies) aim to refine this balance.”

Antithrombotic Therapy

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antithrombotic therapy ASD Atrial Septal Defect Cardiology Health Heart Health Heart Interventions Hematology Hemostasis Hemostasis Today LAAO Left Atrial Appendage Occlusion Medicine Mitral Interventions Patent Foramen Ovale PFO Razavi Hospital Seyed Mohsen Jahromi Moghadam TAVI thrombosis Transcatheter Aortic Valve Implantation Transcatheter Structural Heart Interventions Tricuspid Interventions
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