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Association Between Heparin Dose, Body Mass Index, and Stroke Risk in Patients Undergoing TAVR.

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Unfractionated heparin (UFH) dosing and activated clotting time (ACT) levels during transcatheter aortic valve replacement (TAVR) did not significantly impact stroke risk or procedural outcomes in this study. Further randomized trials are needed to establish optimal anticoagulation strategies for TAVR patients.

Keywords:
activated clotting times (ACT)body mass index (BMI)peri-procedural stroketranscatheter aortic valve replacement (TAVR)unfractionated heparin (UFH)

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Area of Science:

  • Cardiology
  • Vascular Surgery
  • Anesthesiology

Background:

  • Unfractionated heparin (UFH) is standard for preventing clots during transcatheter aortic valve replacement (TAVR).
  • Optimal UFH dosing and target activated clotting time (ACT) values for TAVR remain undefined by evidence-based guidelines.
  • This study investigates UFH, ACT, and stroke risk in TAVR patients, stratified by body mass index (BMI).

Purpose of the Study:

  • To assess the relationship between intraprocedural UFH dose, ACT, and peri-procedural stroke risk in TAVR patients.
  • To analyze stroke risk based on BMI (<30 vs. ≥30 kg/m²).
  • To evaluate secondary outcomes including procedural parameters, mortality, and safety.

Main Methods:

  • A cohort of 1045 patients undergoing TAVR for severe aortic stenosis was analyzed.
  • Patients with atrial fibrillation or on chronic anticoagulation were excluded.
  • Stroke occurrence, procedural data, and 1-year mortality were primary and secondary outcomes, with subgroup analysis by BMI and ACT values.

Main Results:

  • Mean heparin dose was 47 U/kg and mean ACT was 218 s; lower BMI patients received higher doses and had higher ACTs.
  • Peri-procedural stroke rates were low (1.1%) and similar across BMI groups (1.2% vs. 0.9%).
  • No significant differences in stroke rates were observed based on ACT values (≤250 vs. >250 s), nor in 1-year mortality or safety outcomes.

Conclusions:

  • In this cohort, variations in UFH dosing and ACT did not correlate with peri-procedural stroke or overall outcomes in TAVR.
  • The low event rate necessitates cautious interpretation of these findings.
  • Prospective randomized trials are essential to determine optimal anticoagulation strategies for TAVR.