In Reply Drs Hough and Woods raise an important clinical issue regarding the management of anticoagulation in patients undergoing TAVR. Specifically they ask about antithrombotic therapy after TAVR in patients with baseline AF. As they correctly point out, approximately 40% of patients undergoing TAVR in the STS/ACC TVT registry had AF at baseline and were presumably already receiving anticoagulant therapy.
The appropriate management of anticoagulation, antiplatelet therapy, or both, after TAVR has not been clearly elucidated. A single center reported a higher risk of stroke lasting 2 months after TAVR, but only a prior history of cerebrovascular disease was a predictor.1
Mack M. Antithrombotic Therapy After Transcatheter Aortic Valve Replacement—Reply. JAMA. 2014;311(12):1250-1251. doi:10.1001/jama.2014.1183