Reduced Leaflet Motion after Transcatheter Aortic-Valve Replacement

This substudy of the GALILEO trial investigated whether a rivaroxaban-based antithrombotic strategy reduced subclinical leaflet-motion abnormalities in patients who had undergone transcatheter aortic-valve replacement (TAVR) without an indication for long-term anticoagulation. At 90 days post-randomization, four-dimensional CT showed that rivaroxaban significantly reduced the incidence of moderate or greater prosthetic leaflet motion restriction (2.1% vs. 10.9%) and leaflet thickening (12.4% vs. 32.4%) compared to antiplatelet therapy. However, the main GALILEO trial found increased risks of death and bleeding with rivaroxaban, tempering enthusiasm for its use solely to prevent subclinical valve abnormalities. The authors recommend against routine anticoagulation or CT screening after TAVR in this patient group.

This substudy of the GALILEO trial investigated whether a rivaroxaban-based antithrombotic strategy reduced subclinical leaflet-motion abnormalities in patients who had undergone transcatheter aortic-valve replacement (TAVR) without an indication for long-term anticoagulation. At 90 days post-randomization, four-dimensional CT showed that rivaroxaban significantly reduced the incidence of moderate or greater prosthetic leaflet motion restriction (2.1% vs. 10.9%) and leaflet thickening (12.4% vs. 32.4%) compared to antiplatelet therapy. However, the main GALILEO trial found increased risks of death and bleeding with rivaroxaban, tempering enthusiasm for its use solely to prevent subclinical valve abnormalities. The authors recommend against routine anticoagulation or CT screening after TAVR in this patient group.