Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic stenosis, providing a less invasive alternative to surgical valve replacement. However, post-TAVR management remains complex, particularly concerning antithrombotic strategies, as patients face competing risks of bleeding and thrombosis. This review explores the evolving landscape of anticoagulation and antiplatelet therapy in TAVR patients, examining current American and European guidelines, clinical trial data, and the role of direct oral anticoagulants. We also highlight the interplay between atrial fibrillation, coronary artery disease, and antithrombotic therapy, emphasizing personalized approaches to patient management. Finally, we discuss complications such as stroke, subclinical leaflet thrombosis, and major bleeding, offering insights into mitigation strategies. As the field continues to evolve, ongoing research will shape future recommendations to optimize outcomes for patients undergoing TAVR.