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Published on: June 3, 2018
Time course of ischemic and bleeding burden in consecutive patients undergoing transcatheter aortic valve replacement
G Esposito1, C Montalto2, G Crimi3
1Interventional Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy; Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy.
Insights
After transcatheter aortic valve replacement (TAVR), ischemic events are more common than bleeding events, particularly in the acute phase. This risk persists regardless of antithrombotic strategy, highlighting a critical area for patient management.
Area of Science:
- Cardiology
- Interventional Cardiology
- Valvular Heart Disease
Background:
- Transcatheter aortic valve replacement (TAVR) is associated with potential ischemic and bleeding events that can impact clinical outcomes.
- Characterizing these risks is crucial for optimizing post-procedural management and improving patient prognosis.
Purpose of the Study:
- To quantify and compare the average daily ischemic risks (ADIRs) and average daily bleeding risks (ADBRs) over one year in patients undergoing TAVR.
- To analyze these risks across different timeframes (acute, late, very late) and in relation to antithrombotic strategies.
Main Methods:
- ADIRs included cardiovascular death, myocardial infarction, and ischemic stroke; ADBRs included all bleeding events per VARC-2 definition.
- Risks were assessed in acute (0-30 days), late (31-180 days), and very late (>181 days) post-TAVR periods.
- Generalized estimating equations were used for statistical comparison, analyzing overall cohort and subgroups based on long-term oral anticoagulation (LT-OAC) use.
Main Results:
- Ischemic burden (ADIRs) was significantly higher than bleeding burden (ADBRs) across all timeframes and in the overall population (ADIRs were threefold ADBRs).
- ADIRs were notably higher in the acute phase post-TAVR, while ADBRs remained relatively stable over time.
- In the LT-OAC group, dual therapy (OAC + SAPT) showed lower ischemic risk but higher bleeding events compared to OAC alone.
Conclusions:
- Average daily risks of ischemic and bleeding events after TAVR fluctuate over time.
- Ischemic risks consistently outweigh bleeding risks, especially during the acute phase and irrespective of the antithrombotic strategy employed.
- Findings underscore the importance of monitoring and managing ischemic complications post-TAVR.
Background And Aims:
Ischemic or bleeding events might occur after transcatheter aortic valve replacement (TAVR), with the potential to hamper clinical outcomes. This study aimed to characterize the average daily ischemic risks (ADIRs) and the average daily bleeding risks (ADBRs) over 1-year in all consecutive patients undergoing TAVR.
Methods:
ADBR included all bleeding events according to VARC-2 definition, and ADIR included cardiovascular deaths, myocardial infarction and ischemic stroke. ADIRs and ADBRs were assessed within different timeframes post TAVR: acute (0-30 days), late (31-180 days), and very late (>181 days). Generalized estimating equations were used to test the least squares mean differences for the pairwise comparison of ADIRs and ADBRs. Our analysis was performed in the overall cohort and according to antithrombotic strategy (LT-OAC vs No LT-OAC).
Results:
Ischemic burden was higher than bleeding burden, independently from the indication to LT-OAC, and in all timeframes examined. In the overall population, ADIRs were three-fold ADBRs (0.0467 [95% CI, 0.0431-0.0506] vs 0.0179 [95% CI, 0.0174-0.0185]; p < 0.001*). While ADIR was significantly higher in the acute phase, ADBR was relatively stable in all timeframes analysed. Of note, in LT-OAC population, OAC + SAPT group showed lower ischemic risk and higher bleeding events compared with OAC alone (ADIR: 0.0447 [95% CI: 0.0417-0.0477] vs 0.0642 [95% CI: 0.0557-0.0728]; p < 0.001*, ADBR 0.0395 [95% CI: 0.0381-0.0409] vs 0.0147 [95% CI: 0.0138-0.0156]; p < 0.001*).
Conclusions:
In patients undergoing TAVR Average daily risk fluctuates over time. However, ADIRs overcome ADBRs in all timeframes, especially in the acute phase and regardless of antithrombotic strategy adopted.
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