Abstract
As transcatheter aortic valve implantation (TAVI) is increasingly used in younger and lower-risk patients, it is important to understand the risk of valve thrombosis in TAVI prostheses and how this may contribute to bioprosthetic valve dysfunction and thromboembolic events. Subclassification of valve thrombosis by incidence or timing is challenged by differences in sensitivity and heterogeneity among the imaging modalities used for its detection. The long-term implications of valve thrombosis - particularly regarding stroke risk and prosthesis longevity - remain uncertain and debated. Current treatment options for valve thrombosis include temporary anticoagulation therapy, thrombolysis, and, in some cases, reintervention. To address these concerns, ongoing research is focused on improving the detection and treatment of valve thrombosis through standardised imaging protocols and the use of intensified antithrombotic regimens that balance the thrombotic and bleeding risks. Prevention of valve thrombosis remains a challenge requiring a better understanding of patient- and procedure-related risk factors. These insights will be essential to individualise antithrombotic therapy and improve prosthesis design. This review outlines current evidence on the mechanisms, prevalence, clinical relevance, and management of TAVI thrombosis and highlights ongoing clinical trials investigating this condition.