Anticoagulation therapy for the prevention of subclinical leaflet thrombosis after transcatheter aortic valve replacement: A comprehensive literature review and future directions

Leaflet thrombosis after transcatheter aortic valve replacement (TAVR) presents a significant challenge, leading to adverse clinical outcomes. Subclinical leaflet thrombosis (SLT) is increasingly recognized, and there is a growing concern about its role in clinical events and hemodynamic valve deterioration. Current recommendations for prophylactic anticoagulation or antiplatelet therapy following TAVR are primarily based on expert consensus rather than definitive evidence from randomized trials, resulting in a variety of antithrombotic strategies in clinical practice. While observational data suggest that prophylactic anticoagulation may be beneficial, clinical trial results are inconsistent, particularly for patients without an existing indication for OAC. Given the conflicting findings and potential safety concerns associated with prophylactic anticoagulation, further research is imperative. This review aims to summarize the existing literature on risk factors for SLT, preventive strategies, current recommendations, and future research directions to better understand the benefits and risks of prophylactic anticoagulation in this context. •Leaflet thrombosis post-TAVR is a significant clinical problem.•There are patient-specific, device-specific, and procedural risk factors for SLT.•Guidelines for antithrombotic and antiplatelet therapy vary.•OAC reduces leaflet thrombosis but increases bleeding risk.•More research is needed to define optimal post-TAVR antithrombotic strategies.