The lower-intensity INR group experienced signifi- cantly less major and minor bleeding, whereas the rates of stroke, transient ischemic attack, total neurological events, and all-cause mortal- ity were similar between the 2 groups. A sub- sequent publication from these investigators showed harm with a strategy of dual-antiplate- let therapy versus low-intensity anticoagulation plus low-dose aspirin.28 The routine use of dual-antiplatelet therapy for 6 months after TAVI, which has been the default strategy since the introduction of this technol- ogy into clinical use, has been not been rigor- ously assessed (see previous discussion). There are several ongoing trials evaluating antithrom- botic strategies after TAVI. A small, single-center RCT of patients receiving a self-expanding TAVI device showed no difference in a composite endpoint of major adverse cardiac and cerebro- vascular events or life-threatening bleeding with aspirin plus clopidogrel versus aspirin alone at Compared with single- agent therapy, dual-antiplatelet therapy may be associated with a higher risk of bleeding and no significant difference in rates of valve leaflet thrombosis, thromboembolism, or valve perfor- Other procedural and patient factors may impact the decision to use dual-antiplatelet therapy. The selective use of VKA therapy might be consid- ered after TAVI in patients at low bleeding risk on an individual basis. 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. 