In the last article, we introduced transcatheter aortic valve replacement (TAVR), a new technology for treating aortic stenosis. In this section, we will continue to explain whether medication is required after a TAVR surgery.

TAVR is one of the fastest-developing technologies in the current medical field. As a new technique to treat severe aortic stenosis, TAVR has gradually become an important alternative to surgical aortic valve replacement and has been used to treat severe patients who are considered unsuitable for conventional surgery. However, reasonable and long-term antithrombotic therapy is also required after a TAVR surgery.

Yet, many patients mistakenly think that they don’t need to take medication after TAVR surgery. Some patients refuse to take medication because they are so worried about the side effects of medication.

To relieve above doubts, we specially collected relevant data for explanations.

Post-surgery medication is for more ensured safety.

Human blood carries a kind of substances called platelets that cause clotting in the presence of “foreign matter”. That is why bleeding from a small accidental cut can stop automatically. After a heart valve is implanted into the heart, blood may coagulate at the prosthetic valve position, thus forming thrombosis that will “block” the valve and accelerate the valve damage. Therefore, post-surgery medication is generally required for a certain period of time for anticoagulation.

According to statistics, plaelet dysfunction occurred to more than 60% of the patients who had undergone a TAVR surgery. That’s probably caused by the high-shear stress of platelets. Besides, the TAVR procedure includes the implantation of a bioprosthetic heart valve, which may also increase the risk of cardiovascular events, especially in the first 3 months after surgery [1]. Therefore, receiving anticoagulation and antiplatelet therapy after a TAVR surgery is safer for patients.

Then, how to take medication after a TAVR surgerys?

In 2018, an article titled Expert consensus on clinical pathway for transcatheter aortic valve replacement in China pointed out:

1. In case of post-surgery requirement for long-term anticoagulation (such as cases combined with an atrial fibrillation or thromboembolic event), long-term use of Vitamin K antagonists (VKAs) is suggested; non-vitamin anticoagulants are not recommended at present due to limited evidence. For patients with atrial fibrillation and considered unsuitable for long-term anticoagulation, simultaneous or elective left auricle occlusion could be considered at the time of performing TAVR.
2. If long-term anticoagulation is not required, the risk of bleeding could be assessed by using the HAS-BLED score. If the risk is low, the suggestion is to receive dual antiplatelet therapy (DAPT) for 6 months and then switch to lifelong medication of a single antiplatelet drug.
3. If a patient is at high risk of bleeding, post-surgery direct medication of a single antiplatelet drug for a long time is recommended.
4. For patients with leaflet thrombosis detected by post-surgery imaging examination, anticoagulation (Vitamin K antagonist therapy) is required. On month later, whole-phase 4D-CT reconstruction and echocardiography shall be performed for the aortic root to reassess and adjust the treatment regimen [2].

Your doctor will tell you above medication principles, so don’t worry too much about how to take medication. You just need to follow your doctor’s advice.

Patients also need to pay attention to the following aspects.

1. Under normal circumstances, patients can get out of bed in 24-48 hours after surgery, and their doctors will decide when they could return to the general ward according to their conditions. In most cases, the length of hospital stay is 3-5 days. In addition, patients undergoing TAVR recover faster and can perform necessary exercises without feeling tired.

2. After TAVR, MRI can be performed, but attention should be paid to the magnetic field intensity and the duration of scanning. 

3. For patients with ventricular dysfunction, it’s better to have a light diet and take no more than 6g of salt a day. During the post-surgery recovery period, it’s recommended to eat more nutritious and digestible food.

4. Infections shall be actively prevented and treated. Mild inflammations caused by dental diseases and cold shall not be neglected and must be treated timely and reasonably for anti-inflammation. After all, with a prothetic valve implanted into the body, any bacteria invading the body is likely to stay at the prothetic valve and cause heart infection.

After reading above explanations, do you have a new awareness of antithrombotic therapy after TAVR? So long as you strictly follow your doctor’s instructions, stay positive in treatment and take medication on time, you could recover well after surgery. You also need to strictly follow relevant precautions after surgery and go to the hospital regularly for reexaminations. Only by fulfilling above requirements, you could regain confidence to live a healthy life.

[1] Sharma, A., Goel, S., Lavie, C. J., Arbab-Zadeh, A., Mukherjee, D., & Lazar, J. (2014). Antithrombotic therapy before, during and after transcatheter aortic valve replacement (TAVR). Journal of Thrombosis and Thrombolysis, 39(4), 467–473. doi:10.1007/s11239-014-1118-x.

 [2] Structural Heart Disease Research Panel, Chinese Society of Cardiology, Chinese Medical Association; Structural Heart Disease Committee, Chinese Association of Cardiovascular Surgeons, Chinese Medical Doctor Association: “The expert consensus on clinical pathway for transcatheter aortic valve replacement in China” [J], Chinese Circulation Journal, 2018,33(12):1162-1169. DOI:10.3969/69/j.issn.100.1000-3614.2018.12.004.