It is not clear whether valve thrombosis and valve deterioration represent the same disease process at different points in time. The late consequence of valve thrombosis may be fibrotic organization of the thrombus, with an increase in valvular gradient; thus, it could be labeled as valve failure. Early detection of valve thrombosis is therefore key.
The study in this issue of the Journal manifests a high incidence of valve thrombosis and shows that anticoagulation is effective in restoring leaflet function . As always in medicine, it is better to prevent than to cure and points to the fact that antithrombotic therapy in the setting of TAVR has only been empirically determined. After TAVR, dual antiplatelet therapy with aspirin (80 to 325 mg/day) and clopidogrel (75 mg/day) has been used in most centers and studies. However, the use of a loading dose of clopidogrel (300 to 600 mg) before TAVR is typically not specified, and the duration of clopidogrel therapy has varied among studies. The same applies for SAVR, in which it is still unclear whether aspirin alone is enough, or if a vitamin K antagonist or a new oral anticoagulant should be added for 3 to 6 months. Without knowing the optimal peri- and postprocedural antithrombotic regimens, clinicians should have an increased awareness of valve thrombosis after SAVR and TAVR.

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Journal of the American College of Cardiology
Department of Cardio-Thoracic Surgery

Kappetein, A. P., & Head, S. (2016). The Clinical Reality With Uncertain Consequences of Biological Valve Thrombosis. Journal of the American College of Cardiology, 68(19), 2070–2072. doi:10.1016/j.jacc.2016.08.042