Antiplatelet therapy in valvular and structural heart disease interventions

Interventions for valvular and structural heart diseases are rapidly expanding. Currently percutaneous approach represents the standard of care in specific subsets of patients as those with high operative risk for traditional open surgery (1). However, these procedures are burdened by a significant risk of embolic complications, such as stroke and myocardial infarction. Thus, antithrombotic therapy represents the cornerstone of adjunctive pharmacologic therapy although type and doses of antiplatelet agents remain mostly empiric for these indications. Of course, there is also a downside. Patients with structural heart diseases undergoing percutaneous procedures are predisposed to a high bleeding risk, because of specific procedural questions, such as vascular access from larger devices, but also of their co-morbidities and frailty. Thus, in this setting, the delicate balance between thrombotic and bleeding risk is crucial