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Late Bleeding Events in Patients Undergoing Percutaneous Coronary Intervention in the Workup Pre-TAVR
Marisa Avvedimento1, Francisco Campelo-Parada2, Erika Munoz-Garcia3
1Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
Insights
Late bleeding events (LBEs) after transcatheter aortic valve replacement (TAVR) with percutaneous coronary intervention (PCI) occur in nearly 8% of patients and increase mortality risk. Combining antiplatelet and anticoagulation therapy elevates LBE risk.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Cardiology
Background:
- Late bleeding events (LBEs) following percutaneous coronary intervention (PCI) in patients awaiting transcatheter aortic valve replacement (TAVR) are not well understood.
- The clinical significance and incidence of LBEs in this specific patient population require further investigation.
Purpose of the Study:
- To investigate the incidence, clinical characteristics, and associated factors of LBEs in patients undergoing PCI before TAVR.
- To determine the impact of LBEs on clinical outcomes, including mortality, after TAVR.
Main Methods:
- A multicenter study involving 1,457 patients who underwent TAVR and survived past 30 days.
- Late bleeding events (LBEs) were defined using Valve Academic Research Consortium-2 criteria, occurring more than 30 days post-TAVR.
Main Results:
- LBEs occurred in 7.9% of patients, with most events being major or life-threatening.
- Independent predictors of LBEs included periprocedural bleeding and dual antiplatelet plus anticoagulation therapy.
- LBEs were associated with a significantly increased 4-year all-cause mortality risk post-TAVR.
Conclusions:
- Late bleeding events are common in TAVR patients with coronary artery disease requiring PCI and are linked to higher mortality.
- Strategies to prevent LBEs are crucial, especially considering the increased risk associated with combined antithrombotic therapies.
- Further research is needed to establish optimal antithrombotic regimens for this high-risk group.
Background:
In patients undergoing percutaneous coronary intervention (PCI) in the work-up pre-transcatheter aortic valve replacement (TAVR), the incidence and clinical impact of late bleeding events (LBEs) remain largely unknown.
Objectives:
This study sought to determine the incidence, clinical characteristics, associated factors, and outcomes of LBEs in patients undergoing PCI in the work-up pre-TAVR.
Methods:
This was a multicenter study including 1,457 consecutive patients (mean age 81 ± 7 years; 41.5% women) who underwent TAVR and survived beyond 30 days. LBEs (>30 days post-TAVR) were defined according to the Valve Academic Research Consortium-2 criteria.
Results:
LBEs occurred in 116 (7.9%) patients after a median follow-up of 23 (IQR: 12-40) months. Late bleeding was minor, major, and life-threatening or disabling in 21 (18.1%), 63 (54.3%), and 32 (27.6%) patients, respectively. Periprocedural (<30 days post-TAVR) major bleeding and the combination of antiplatelet and anticoagulation therapy at discharge were independent factors associated with LBEs (P ≤ 0.02 for all). LBEs conveyed an increased mortality risk at 4-year follow-up compared with no bleeding (43.9% vs 36.0; P = 0.034). Also, LBE was identified as an independent predictor of all-cause mortality after TAVR (HR: 1.39; 95% CI: 1.05-1.83; P = 0.020).
Conclusions:
In TAVR candidates with concomitant significant coronary artery disease requiring percutaneous treatment, LBEs after TAVR were frequent and associated with increased mortality. Combining antiplatelet and anticoagulation regimens and the occurrence of periprocedural bleeding determined an increased risk of LBEs. Preventive strategies should be pursued for preventing late bleeding after TAVR, and further studies are needed to provide more solid evidence on the most safe and effective antithrombotic regimen post-TAVR in this challenging group of patients.
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