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Updated: Jan 23, 2026

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Types of Bleeding Following Mechanical Aortic Valve Replacement.

Ruixin Lu1, Michael Dismorr1,2, Natalie Glaser1,3

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European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|January 21, 2026
PubMed
Summary

Mechanical aortic valve replacement (AVR) patients frequently experience major bleeding events. Gastrointestinal and intracranial bleeding are the most common complications, highlighting the need for improved preventative strategies.

Keywords:
Major bleedingMechanical aortic valve replacementTypes of bleeding

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Area of Science:

  • Cardiology
  • Vascular Surgery
  • Public Health

Background:

  • Mechanical aortic valves offer durability but necessitate lifelong anticoagulation.
  • Anticoagulation therapy increases the risk of bleeding complications.
  • Specific bleeding patterns after mechanical aortic valve replacement (AVR) are not well-characterized.

Purpose of the Study:

  • To investigate the types and incidence of major bleeding complications following mechanical AVR.
  • To identify the most frequent bleeding sites in patients with mechanical aortic valves.

Main Methods:

  • Nationwide, observational cohort study in Sweden (1997-2022).
  • Inclusion of all patients undergoing mechanical AVR, identified via the SWEDEHEART registry.
  • Primary outcome: first major bleeding event requiring hospitalization, identified using International Classification of Diseases (ICD) codes from the Swedish National Patient Register.

Main Results:

  • 13,508 patients underwent mechanical AVR; 15% (2029) experienced a major bleeding event.
  • Gastrointestinal bleeding (40%) and intracranial bleeding (24%) were the most common complications.
  • At 20 years, cumulative incidences were 9.0% for gastrointestinal and 5.3% for intracranial bleeding.

Conclusions:

  • Gastrointestinal and intracranial bleeding dominate bleeding complications post-mechanical AVR.
  • Hematuria and epistaxis are also significant bleeding concerns.
  • Further research is required to develop strategies for reducing bleeding risk in this patient group.