Dual antiplatelet therapy after TAVR: A drop in the bucket?

Current guidelines recommend a three- to six-months dual antiplatelet therapy (DAPT) in patients undergoing transcatheter aortic valve replacement (TAVR) or to continue with oral anticoagulant agents (OAC) if already indicated before procedure. However, recent studies showed that treatment with aspirin has the same efficacy of DAPT but it was associated with a significant reduction of major bleeding. Furthermore, half of cerebrovascular events, occurring >24 h after procedure, may be related to new onset of atrial fibrillation or to subclinical leaflets thrombosis and they may be prevented by use of OAC rather than antiplatelet therapy. In absence of very high bleeding risk and of recent percutaneous coronary intervention, the use of OAC over SAPT or DAPT might theoretically be considered in patients undergoing TAVR waiting for results of ongoing clinical trials.