Effectiveness of anticoagulant therapy in the treatment of post-TAVI bioprosthetic thrombosis
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CASE REPORT
Open Access
Effectiveness of anticoagulant therapy in the treatment of post-TAVI bioprosthetic thrombosis Jérémy Descoux, Pierre Gautier-Pignonblanc, Andrea Innorta, Nicolas Durel, Lionel Camilleri, Pascal Motreff, Jean-René Lusson and Geraud Souteyrand*
Abstract Bioprosthetic thromboses are rarely reported in post-transcatheter aortic valve implantation (TAVI). We describe herein the case of bioprosthetic valve thrombosis in an 82-year-old patient which resolved completely after anticoagulant therapy. Keywords: Thrombosis, Bioprosthesis, TAVI, Anticoagulation, Echocardiography, Aortic stenosis, Male, > 80 years
Background Aortic valve replacement enables to reduce symptoms and improve morbidity and mortality in patients with severe aortic stenosis [1]. Transcatheter valve replacement represents a safe and well-recognized alternative in inoperable and/or high-operative-risk patients (EuroSCORE, STS) [2-4]. Antithrombotic therapy in the setting of TAVI has been empirically determined, with the most commonly recommended treatment consisting of unfractionated heparin during the procedure followed by dual antiplatelet therapy with aspirin (indefinitely) and clopidogrel (1 to 6 months) [5-7]. To date, there are no referenced cases of described valvular thrombosis in the large prospective cohorts addressing post-TAVI follow-up [8-10]. Other published reports include one case of an Edwards SAPIEN 23 mm valve dysfunction requiring re-operation [11] , one case of early transcatheter aortic valve thrombosis (2 weeks) requiring a second intervention [12]., one case of valve thrombosis which could not be treated by warfarin and requiring surgical intervention [13], one case of prosthesis thrombosis with restricted cusp movement and conserved pressure gradient with complete disappearance 10 weeks after reintroduction of anticoagulant therapy [14], one case of thrombotic aortic stenosis of an Edwards SAPIEN 26 mm valve occurring 4 months after * Correspondence: [email protected] Centre Hospitalier Universitaire de Clermont Ferrand and the Faculty of Medicine of Clermont-Ferrand, Université d’Auvergne, Clermont-Ferrand, France
the procedure with total recovery upon vitamin K antagonist (VKA) therapy [15]. Leetma et al. furthermore described 2 cases of refractory heart failure leading to death at respectively day 106 and day 137 following transapical TAVI [16]. Cota et al. also described 3 cases of bioprosthetic dysfunction resulting from valve thrombosis, at respectively 10, 4 and 2 months, all of which were treated with VKA therapy with ad integrum restitution within 2–3 months [17]. Finally, Latib et al. reported 3 cases of SAPIEN XT valve thrombosis assessed during TAVI-follow up, at respectively 6, 15 and 24 months. All three cases were treated with VKA therapy with complete restitution within 1–2 months [18].
Case presentation We report herein the case of an 82-year-old patient with a respective history of idiopathic thrombocytopenic purpura (ITP), type 2 diabetes, treated dyslipidemia and
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