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Major Bleeding Risk Assessment With Atrial Fibrillation Post-TAVR: The HARHP Score Results From ENVISAGE-TAVI AF.

George D Dangas1, Martin Unverdorben2, Christian Hengstenberg3

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PubMed
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A new HARHP score identifies major bleeding risk in atrial fibrillation patients post-TAVR. This score, based on hemoglobin, alcohol use, renal impairment, hypercholesterolemia, and recent PCI, helps stratify patients for better anticoagulation management.

Keywords:
TAVRbleedingedoxabantranscatheter aortic valve replacementvitamin K antagonist

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Area of Science:

  • Cardiology
  • Transcatheter Aortic Valve Replacement (TAVR)
  • Atrial Fibrillation (AF) management

Background:

  • Estimating major bleeding (MB) risk in atrial fibrillation (AF) patients after transcatheter aortic valve replacement (TAVR) is crucial for guiding anticoagulation strategies.
  • Current risk stratification tools may not fully capture bleeding risks specific to this patient population.

Purpose of the Study:

  • To identify independent predictors of major bleeding (MB) in patients with AF following TAVR.
  • To develop a risk assessment score for MB in this cohort.

Main Methods:

  • On-treatment analysis of the ENVISAGE-TAVI AF study (NCT02943785).
  • Stepwise Cox regression identified MB predictors from baseline characteristics.
  • A point-based additive score (HARHP) was constructed and patients stratified into risk groups.

Main Results:

  • 1377 patients analyzed; 10.1% experienced MB over 1.3 ± 0.8 years.
  • The HARHP score comprises low hemoglobin, excessive alcohol use, severe renal impairment, hypercholesterolemia, and recent PCI (within 30 days).
  • High-risk patients (score ≥ 4) had 6.5 times higher MB likelihood than low-risk patients (score 0-1).

Conclusions:

  • The HARHP score effectively identifies independent predictors of long-term MB in AF patients post-TAVR.
  • This score can aid in assessing MB risk and potentially improve patient outcomes through tailored anticoagulation management.