Subclinical Leaflet Thrombosis and Subclinical Aortic Valve Complex Thrombosis in TAVR.

Subclinical leaflet thrombosis (SLT) following transcatheter aortic valve replacement occurs in 10% to 15% of patients at 1 month and up to 30% by 1 year, extending to perivalvular structures as subclinical aortic valve-complex thrombosis. We review contributing factors to SLT, including valve-specific parameters such as flow dynamics in the native sinus and neosinus, prosthesis sizing, deployment symmetry, implant depth, and commissural alignment; the persistent metabolic activity of retained calcified leaflets; and the impact of antithrombotic therapy on SLT incidence. Although oral anticoagulation reduces imaging-detected SLT, it increases bleeding and mortality. This review offers a comprehensive analysis integrating device geometry, sinus flow dynamics, and native tissue activity to inform personalized, time-limited anticoagulation strategies in high-risk patients, thereby optimizing the thrombosis-bleeding balance and enhancing transcatheter aortic valve replacement outcomes.