Treatment after TAVR — Discordance and Clinical Implications

This editorial analyzes the discordant results of the GALILEO trial, which evaluated rivaroxaban versus antiplatelet therapy following transcatheter aortic-valve replacement (TAVR). While imaging showed reduced hypoattenuated leaflet thickening and improved leaflet motion with rivaroxaban, patients experienced higher rates of death, thromboembolic events, and bleeding. The authors argue that attempts to prevent subclinical leaflet thrombosis may actually result in more harm than benefit. They caution against routine use of direct oral anticoagulants after TAVR until further evidence clarifies clinical relevance and safety. The article emphasizes a need for targeted follow-up studies to resolve uncertainty about anticoagulation strategies and their implications for valve durability and patient outcomes.

This editorial analyzes the discordant results of the GALILEO trial, which evaluated rivaroxaban versus antiplatelet therapy following transcatheter aortic-valve replacement (TAVR). While imaging showed reduced hypoattenuated leaflet thickening and improved leaflet motion with rivaroxaban, patients experienced higher rates of death, thromboembolic events, and bleeding. The authors argue that attempts to prevent subclinical leaflet thrombosis may actually result in more harm than benefit. They caution against routine use of direct oral anticoagulants after TAVR until further evidence clarifies clinical relevance and safety. The article emphasizes a need for targeted follow-up studies to resolve uncertainty about anticoagulation strategies and their implications for valve durability and patient outcomes.