{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T12:51:56Z","timestamp":1792068716019,"version":"4.4.0"},"reference-count":84,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Perfusion"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Bioprosthetic aortic valve replacement, specifically surgical (SAVR) and transcatheter (TAVR), is among the most frequently performed cardiac interventions globally, yet anticoagulation strategies after implantation remain incompletely defined. Atrial fibrillation, notably prevalent pre- and post-operatively in these patients, substantially amplifies thromboembolic risk and complicates decision-making in an already elderly, frail, and comorbid population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To critically evaluate current anticoagulation strategies after bioprosthetic aortic valve replacement across sinus rhythm and atrial fibrillation in both SAVR and TAVR, and to identify evidence gaps and guideline inconsistencies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a narrative review of major international guidelines (ESC\/EACTS 2025, ACC\/AHA 2020, and NICE 2021) and key clinical trials on antithrombotic therapy in valve replacement populations. Focus was placed on bioprosthetic aortic valve replacement, with mechanical and non-aortic valves excluded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Aspirin monotherapy is the most consistently supported strategy after bioprosthetic TAVR in sinus rhythm, though guidelines diverge on duration and recommendation strength. In atrial fibrillation, all three guidelines apply uniform CHA\n                      <jats:sub>2<\/jats:sub>\n                      DS\n                      <jats:sub>2<\/jats:sub>\n                      -VASc-based frameworks irrespective of AF phenotype, procedural context, or detection modality, reflecting lacking evidence rather than deliberate clinical judgement. No trial has enrolled patients specifically with new-onset post-procedural AF or stratified by AF subtype, and subclinical AF after bioprosthetic AVR remains entirely uncharacterised.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Guideline divergence reflects a structurally inadequate evidence base rather than genuine clinical equipoise. Individualised decisions informed by procedure type, AF phenotype, frailty, and bleeding risk are required to guide clinical practice, alongside an adequately powered stratified randomised trial incorporating mandatory continuous rhythm monitoring.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02676591261496740","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T14:01:17Z","timestamp":1791813677000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Anticoagulation after transcatheter and surgical bioprosthetic aortic valve replacement: A narrative review"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1374-5143","authenticated-orcid":false,"given":"Sammy","family":"Arab","sequence":"first","affiliation":[{"name":"Imperial College London"},{"name":"Mayo Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8061-6237","authenticated-orcid":false,"given":"Karanjot","family":"Chhatwal","sequence":"additional","affiliation":[{"name":"Imperial College London"},{"name":"Imperial College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rasi","family":"Mizori","sequence":"additional","affiliation":[{"name":"King\u2019s College London, GKT School of Medical Education"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnav","family":"Rustogi","sequence":"additional","affiliation":[{"name":"University College London Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhtasim","family":"Fuad","sequence":"additional","affiliation":[{"name":"The University of Manchester"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Balamrit Singh","family":"Sokhal","sequence":"additional","affiliation":[{"name":"Keele University"},{"name":"Royal Stoke University Hospital, University Hospitals North Midlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Issam","family":"Motairek","sequence":"additional","affiliation":[{"name":"Cleveland Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1496-8103","authenticated-orcid":false,"given":"Nader","family":"Al-Shakarchi","sequence":"additional","affiliation":[{"name":"Mayo Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raheel","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Newcastle University"},{"name":"Freeman Hospital"},{"name":"Royal Brompton Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monjur","family":"Showkat","sequence":"additional","affiliation":[{"name":"Imperial College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prakash","family":"Punjabi","sequence":"additional","affiliation":[{"name":"Hammersmith Hospital, Imperial College Healthcare NHS Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2012-302265"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41569-021-00570-z"},{"key":"e_1_3_6_4_2","first-page":"e07","article-title":"Incidence and pathology of aortic regurgitation","volume":"20","author":"de Assis LU","year":"2025","unstructured":"de Assis LU, Mondellini GM, van den Dorpel MM, et al. 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