Antithrombotic strategies in valvular and structural heart disease interventions

Intervention for valvular and structural heart disease is an exponentially growing field within interventional cardiology. Drugs and regimens for antiplatelet and anticoagulant therapy for valvular and structural interventions are mostly empirical in daily practice and typically administered at the operator’s discretion. This chapter reviews the current evidence supporting the rationale for antithrombotic management of patients undergoing transcatheter aortic valve implantation (TAVI), percutaneous mitral valve repair with the Mitraclip system, patent foramen ovale (PFO), atrial septal defect (ASD) closure, and left atrial appendage closure (LAAC). It describes common strategies for managing antiplatelet and anticoagulant therapy in patients with valvular and structural heart disease undergoing transcatheter procedures. The chapter provides insights on future directions and research lines in this field. The approach to antithrombotic prophylaxis against valve or device-related thromboembolic complications in valvular and structural transcatheter intervention is currently empiric.