Abstract
Transcatheter aortic valve implantation (TAVI) has become the standard of care for patients with severe symptomatic aortic stenosis, yet valve thrombosis remains a clinically significant challenge. This review provides a comprehensive overview of the definition, classification, pathophysiology, diagnostic strategies, clinical implications, treatment, prevention, and long-term management of valve thrombosis after TAVI, based on a selective appraisal of clinical studies, randomized trials, meta-analyses and current international guidelines. Subclinical leaflet thrombosis (SLT) is relatively common, typically detected by multidetector computed tomography (MDCT) or transesophageal echocardiography (TEE), though its prognostic significance remains controversial. In contrast, clinical valve thrombosis (CVT) is rare but associated with severe outcomes and is more readily identified by transthoracic echocardiography (TTE). Considerable debate persists regarding optimal antithrombotic strategies, particularly the role of oral anticoagulation versus antiplatelet therapy and the choice between direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs). Major evidence gaps include the lack of validated risk prediction tools, uncertainty about the prognostic impact of SLT, and limited data to guide an optimal antithrombotic regimen. Future research should focus on risk stratification scores, circulating biomarkers, and advanced imaging modalities to improve early detection and management. In summary, optimal management of post-TAVI thrombosis requires an individualized approach that carefully balances thrombotic and bleeding risks, guided by forthcoming high-quality evidence from multicenter randomized trials.