Antithrombotic strategies after TAVI in light of cerebral microembolism

Transcatheter aortic valve implantation (TAVI) has transformed the treatment landscape of aortic stenosis. During the procedure, microembolisation of valve debris and foreign materials may occur, potentially resulting in subclinical cerebral abnormalities. Diffusion-weighted magnetic resonance imaging (DW-MRI) studies have shown new cerebral lesions in a significant proportion of TAVI patients1. Despite a substantial decline in overt stroke with newer-generation valves, cerebrovascular embolisation persists. Hence, the quest to mitigate post-TAVI stroke risk continues through cerebral embolic protection or antithrombotic strategies.

In this issue of EuroIntervention, Jimenez Diaz et al report on the results of the AUREA trial: a single-centre pilot study addressing an important gap by comparing dual antiplatelet therapy (DAPT) with oral anticoagulation (OAC) for reducing cerebral microembolism post-TAVI in patients without an indication for OAC. Patients were randomised to either DAPT or a vitamin K antagonist (VKA) for 3 months post-TAVI2. DW-MRI was performed at baseline and at 6 and 90 days after TAVI. Cerebral embolism was detected in over 75% of patients in both arms. While the number of lesions was similar, DAPT was associated with a significantly...