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Association Between Transcatheter Aortic Valve Replacement and Early Postprocedural Stroke.

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Stroke rates after transcatheter aortic valve replacement (TAVR) remained stable between 2011 and 2017. Postprocedural stroke significantly increased 30-day mortality risk but was not associated with dual antiplatelet or oral anticoagulant therapy.

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Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Public Health

Background:

  • Reducing postprocedural stroke is crucial for improving the safety and outcomes of transcatheter aortic valve replacement (TAVR).
  • Understanding stroke trends and risk factors following TAVR is essential for optimizing patient care.

Purpose of the Study:

  • To evaluate 30-day stroke trends after TAVR in the US during its initial 5 years of use.
  • To assess the association between postprocedural stroke and 30-day mortality.
  • To examine the impact of medical therapy on 30-day stroke risk.

Main Methods:

  • Retrospective cohort study of 101,430 patients undergoing TAVR from November 2011 to May 2017.
  • Analysis of 30-day stroke and transient ischemic attack rates.
  • Cox proportional hazards models and propensity-score matching were used to assess mortality and therapy associations.

Main Results:

  • The overall 30-day stroke rate was 2.3%, with rates remaining stable throughout the study period (P=.22).
  • Stroke within 30 days significantly increased mortality risk (HR, 6.1; P<.001).
  • Neither dual antiplatelet therapy nor oral anticoagulant therapy at discharge was associated with reduced 30-day stroke risk.

Conclusions:

  • The incidence of 30-day stroke following TAVR in the US has remained stable.
  • Post-TAVR stroke is a significant independent predictor of 30-day mortality.
  • Current antithrombotic medical therapies at discharge do not appear to influence 30-day stroke risk.