Hypoattenuated leaflet thickening (HALT) is seen on CT in roughly a quarter to a third of transcatheter valves in the first year. Most patients are asymptomatic and have normal valve gradients. HALT can come and go without treatment, and imaging it routinely has never been shown to improve outcomes. What should prompt action is a rising mean gradient on echo, new thromboembolic symptoms or reduced leaflet motion with haemodynamic consequence.
- Do not request routine CT after TAVR to look for leaflet thickening in asymptomatic patients.
- Follow valve function with echocardiography; a rising mean gradient is the signal that matters.
- Treat clinical valve thrombosis — raised gradients or embolic events — with anticoagulation.
- Asymptomatic HALT alone is not an indication to start a DOAC.
Why it matters
Chasing an imaging sign with anticoagulation exposes older patients to real bleeding risk for an uncertain benefit.
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