*Corresponding author: Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str. 25, DE-53105 Bonn, Germany. E-mail: jan-malte.sinning@ukb.uni-bonn.de
An 80-year-old male patient with symptomatic, severe aortic stenosis, coronary artery disease and permanent atrial fibrillation was referred for transcatheter aortic valve implantation (TAVI). After staged percutaneous coronary intervention of the LAD with drug-eluting stents, he suffered from recurrent lower gastro-intestinal bleeding under triple anticoagulation (acetylsalicylic acid, clopidogrel, and phenprocoumon). Due to high surgical risk (STS score 11.8%) and high risk for stroke (CHA2DS2-VASC score 6) and recurrent bleeding (HASBLED score 4), he underwent transfemoral…