Related Experiment Video
Updated: Sep 9, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Refining Bleeding Risk Stratification After TAVR: Added Value of CT-ADP Beyond High Bleeding Risk Criteria
Shinnosuke Kikuchi1, Antonin Trimaille2, Adrien Carmona3
1Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France; UR 3074 Translational Cardiovascular Medicine, Centre de Recherche en Biomédecine de Strasbourg, University of Strasbourg, France; Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
Background:
Acquired von Willebrand factor deficiency is a key contributor to bleeding after transcatheter aortic valve replacement (TAVR).
Objectives:
The aim of this study was to evaluate whether assessing primary hemostatic disorder using closure time of adenosine diphosphate (CT-ADP), a marker of von Willebrand factor dysfunction, enhances bleeding risk stratification in TAVR patients at high bleeding risk (HBR).
Methods:
A total of 884 patients from a prospective TAVR registry were analyzed. The primary endpoint was 2-year major bleeding. HBR was defined using the Valve Academic Research Consortium for High Bleeding Risk (VARC-HBR) criteria. Primary hemostatic disorder was defined as CT-ADP >180 seconds, measured before and 24 hours post-TAVR.
Results:
VARC-HBR criteria were met in 614 patients (69%). CT-ADP significantly decreased from pre-TAVR to 24 hours postprocedure (170 seconds [124-300 seconds] vs 125 seconds [97-180 seconds]; P < 0.0001). Postprocedural CT-ADP >180 seconds was observed in 220 patients (25%). Patients meeting the VARC-HBR criteria had a higher incidence of 2-year major bleeding than those without (21.7% vs 10.5%; log-rank P < 0.0001). Among patients meeting VARC-HBR criteria, those with postprocedural CT-ADP >180 seconds had a higher 2-year bleeding rate (37.0% vs 16.4%; log-rank P < 0.0001). Adding postprocedural CT-ADP >180 seconds to VARC-HBR score significantly improved predictive accuracy for 2-year bleeding (from 0.65 to 0.69; P = 0.00012). Landmark analysis showed that although meeting the VARC-HBR criteria predicted periprocedural bleeding, it did not predict late bleeding. However, postprocedural CT-ADP >180 seconds identified patients at increased risk for late bleeding among those meeting VARC-HBR criteria (11.4% vs 2.4%; log-rank P < 0.0001).
Conclusions:
Postprocedural CT-ADP assessment enhances bleeding risk stratification beyond VARC-HBR criteria and may support individualized management strategies in high-risk TAVR patients.
Frequently Asked Questions
Based on this study's findings, a closure time of adenosine diphosphate (CT-ADP) exceeding 180 seconds signifies von Willebrand factor (vWF) dysfunction. In patients meeting high bleeding risk criteria, this specific hemostatic impairment was associated with a 37.0% major bleeding rate over two years.
The researchers measured a significant reduction in the median closure time of adenosine diphosphate (CT-ADP) from 170 seconds pre-TAVR to 125 seconds at twenty-four hours post-procedure. This change, which reached a statistical significance of P<0.0001, reflects a partial recovery of primary hemostatic function.
The team used the VARC-HBR framework to identify 614 patients with elevated clinical risk profiles. While these criteria successfully predicted periprocedural bleeding, the study demonstrated that adding CT-ADP measurements improved the overall predictive accuracy for two-year outcomes from a c-index of 0.65 to 0.69.
The landmark analysis showed that while the VARC-HBR criteria effectively identified risks for immediate periprocedural bleeding, they failed to predict late bleeding events. Only the postprocedural CT-ADP measurement successfully identified patients at a higher risk for late complications, specifically 11.4% versus 2.4%.
The study's authors propose that postprocedural assessment of the closure time of adenosine diphosphate (CT-ADP) should be used to support individualized management strategies. This refined stratification helps clinicians tailor care for high-risk patients who exhibit persistent von Willebrand factor dysfunction after their valve replacement.
More Related Videos
06:02Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
06:59Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
Published on: June 3, 2018
Related Concept Videos
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:29Venous Thrombosis III: Interprofessional Care