TY - JOUR
T1 - Subclinical leaflet thrombosis in transcatheter aortic valve replacement detected by multidetector computed tomography ― A review of current evidence
AU - Zainul Rashid, Hashrul Nizam
AU - Brown, Adam John Dunbar
AU - McCormick, Liam
AU - Amiruddin, Ameera S.
AU - Be, Kim K
AU - Cameron, James Donald
AU - Nasis, Arthur
AU - Gooley, Robert Peter
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Subclinical leaflet thrombosis (SLT) following transcatheter aortic valve replacement (TAVR) has been increasingly recognized. SLT has the hallmark features of hypo-attenuated leaflet thickening (HALT) on multidetector computed tomography (MDCT), which may result in hypoattenuation affecting motion (HAM). The actual prevalence of this condition is uncertain, with limited observational registries. SLT has caught the attention of the cardiovascular community because of concerns regarding its clinical sequelae, specifically the potential increased incidence of cerebrovascular events. There are available, albeit sparse, data to suggest that when left untreated, SLT may lead to valve deterioration with potential hemodynamic compromise and potentially clinically overt prostheses thrombosis. Some clinicians have opted to treat patients with SLT with anticoagulation. Although anticoagulation may be a rational treatment option, little data exist on the safety and efficacy of this treatment. This is particularly important considering TAVR patients also have higher bleeding risk than the standard population. In this review, we aim to summarize the current evidence on SLT, explore its pathophysiological mechanism, discuss the current treatment options and future trials that may clarify the optimal antithrombotic strategies of SLT.
AB - Subclinical leaflet thrombosis (SLT) following transcatheter aortic valve replacement (TAVR) has been increasingly recognized. SLT has the hallmark features of hypo-attenuated leaflet thickening (HALT) on multidetector computed tomography (MDCT), which may result in hypoattenuation affecting motion (HAM). The actual prevalence of this condition is uncertain, with limited observational registries. SLT has caught the attention of the cardiovascular community because of concerns regarding its clinical sequelae, specifically the potential increased incidence of cerebrovascular events. There are available, albeit sparse, data to suggest that when left untreated, SLT may lead to valve deterioration with potential hemodynamic compromise and potentially clinically overt prostheses thrombosis. Some clinicians have opted to treat patients with SLT with anticoagulation. Although anticoagulation may be a rational treatment option, little data exist on the safety and efficacy of this treatment. This is particularly important considering TAVR patients also have higher bleeding risk than the standard population. In this review, we aim to summarize the current evidence on SLT, explore its pathophysiological mechanism, discuss the current treatment options and future trials that may clarify the optimal antithrombotic strategies of SLT.
KW - Aortic stenosis
KW - Thrombosis
KW - Transcatheter aortic valve replacement/implantation
UR - http://www.scopus.com/inward/record.url?scp=85049041353&partnerID=8YFLogxK
U2 - 10.1253/circj.CJ-17-1363
DO - 10.1253/circj.CJ-17-1363
M3 - Review Article
AN - SCOPUS:85049041353
SN - 1346-9843
VL - 82
SP - 1735
EP - 1742
JO - Circulation Journal
JF - Circulation Journal
IS - 7
ER -