The PARTNER 2 investigators reported that the use of an anticoagulant (95% warfarin) after TAVI in intermediate or higher surgical risk patients was associated with a lower incidence of an increase in mean gradient >10 mmHg over the first year after implantation.23 This Doppler finding may reflect the development of leaflet thrombosis, for which a change in the frequency of follow-up examinations or treatment could be considered. VKAs may be more effective than direct oral anticoagulants for reduction of death, myocardial infarction, and cerebrovascular events in patients undergoing TAVI with an indi- cation for anticoagulation.33 The selective short- term use of VKAs after ViV TAVI is predicated on the observation that valve thrombosis may be more frequent in this patient population.32 The GALILEO (Global Study Comparing a Rivaroxaban-based Antithrombotic Strategy to an Antiplatelet-based Strategy after Transcatheter Aortic Valve Replacement to Optimize Clinical Outcomes) trial assessed a strategy of low-dose rivaroxaban (10 mg daily) plus low-dose aspirin (75 100 mg daily) versus an antiplatelet strategy CLINICAL STATEMENTS AND GUIDELINES of low-dose aspirin plus clopidogrel (75 mg daily). The study was terminated prematurely by the Data and Safety Monitoring Board because of safety concerns. The rivaroxaban strategy was associated with a higher risk of death or thrombo- embolic complications and a higher risk of bleed- ing than those seen with the antiplatelet-based Dabigatran was compared with warfarin in the RE-ALIGN (Randomized, Phase II Study to Evaluate the Safety and Pharmacokinetics of Oral Dabigatran Etexilate in Patients after Heart Valve Replacement) trial. It was stopped prematurely for excessive thrombotic and bleeding complications in the dabigatran arm.4,5 The safety and efficacy of conventional-dose oral anti-Xa agents in patients with a mechanical valve prosthesis have not been evaluated.33 36 11.3. 