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Updated: Nov 2, 2025
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Predictors of Early Stroke or Death in Patients Undergoing Transcatheter Aortic Valve Implantation
Jean-Baptiste Ricco1, Hélène Castagnet2, Luc Christiaens3
1Department of Clinical Research, CHU La Milétrie, Poitiers, France and University of Poitiers, France..
Insights
Early stroke after Transcatheter Aortic Valve Implantation (TAVI) is a concern. A single antithrombotic agent post-TAVI independently predicted stroke or death, while dual or triple agents did not increase bleeding risk.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Neurology
Background:
- Postoperative stroke is a known complication of Transcatheter Aortic Valve Implantation (TAVI).
- Predictors of early stroke following TAVI have not been extensively reviewed.
- This study aimed to identify factors associated with early stroke after TAVI.
Purpose of the Study:
- To estimate the incidence of stroke within 30 days post-TAVI.
- To identify predictors of early stroke and death following TAVI.
- To evaluate the safety and efficacy of different antithrombotic regimens post-TAVI.
Main Methods:
- A retrospective analysis of 506 consecutive patients undergoing TAVI from January 2017 to June 2019.
- Univariate and logistic regression analyses were performed on preoperative, intraoperative, and postoperative characteristics.
- Outcomes assessed included stroke, death, and bleeding within 30 days post-TAVI.
Main Results:
- The incidence of stroke within 30 days post-TAVI was 4.9%, with a 16% mortality rate among stroke patients.
- Predictors of early stroke included a CHA2Ds2VASc score ≥ 5, supra-aortic access, and a single antithrombotic agent post-TAVI.
- A single antithrombotic agent and prior coronary artery bypass surgery/stenting were associated with significantly higher 30-day mortality risk.
Conclusions:
- A single post-TAVI antithrombotic regimen independently predicted early stroke or death.
- Dual or triple antithrombotic regimens were not associated with increased bleeding risk.
- Dual or triple antithrombotic therapy should be considered for patients undergoing TAVI.
Background/Objective:
While postoperative stroke is a known complication of Transcatheter Aortic Valve Implantation (TAVI), predictors of early stroke occurrence have not been specifically reviewed. The objective of this study was to estimate the predictors and incidence of stroke during the first 30 days post-TAVI.
Methods:
A cohort of 506 consecutive patients having undergone TAVI between January 2017 and June 2019 was extracted from a prospective database. Preoperative, intraoperative and postoperative characteristics were analyzed by univariate analysis followed by logistic regression to find predictors of the occurrence of stroke or death within the first 30 days after the procedure.
Results:
Incidence of stroke within 30 days post-TAVI was 4.9%, [CI 95% 3.3-7.2], i.e., 25 strokes. Four out of the 25 patients (16%) with a stroke died within 30 days post-TAVI. After logistic regression analysis, the predictors of early stroke related to TAVI were: CHA2Ds2VASc score ≥ 5 (odds ratio [OR] 2.62; 95% CI: 1.06-6.49; p = .037), supra-aortic access vs. femoral access (OR: 9.00, 95%CI: 2.95-27.44; p = .001) and introduction post-TAVI of a single vs. two or three antithrombotic agents (OR: 5.13; CI 95%: 1.99 to 13.19; p = .001). Over the 30-day period, bleeding occurred in 28 patients (5.5%), in 25 of whom, it was associated with femoral or iliac artery access injury. Anti-thrombotic regimen was not associated with bleeding; two patients out of 48 (4.1%) bled with a single anti-thrombotic regimen vs. 26 patients out of 458 (5.6%) with a dual or triple anti-thrombotic regimen (p = 0.94). The overall 30-day mortality rate was 3.9%, [95% CI 2.5-6.0]. Patients with a single post-TAVI antithrombotic agent (OR: 44.07 [CI 95% 13.45-144.39]; p < .0001) and patients with previous coronary artery bypass surgery or coronary artery stenting (OR: 6.16, [CI 95% 1.99-21.29]; p = .002) were at significantly higher risk of death within the 30-day period.
Conclusion:
In this large-scale single-center retrospective study, a single post-TAVI antithrombotic regimen independently predicted occurrence of early stroke or death. Dual or triple antithrombotic regimen was not associated with a higher risk of bleeding and should be considered as an option in patients undergoing TAVI.
