Prolonged Clotting Time Among Patients Undergoing Transcatheter Aortic Valve Replacement

Dauerman, Harold L.; DeStephan, Christine M.; Sommer, Heidi Taatjes; Kurchena, Kathryn; DeSarno, Michael; Mendoza, Erika G.; Henderson, Amy; Schneider, David J.

doi:10.1016/j.jacc.2019.06.022

Cited by 5 publications

(4 citation statements)

References 5 publications

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“…Recent evidence demonstrated superiority for restrictive antithrombotic strategies after TAVI [30,31]. Additional analyses suggested that patients after TAVI may have hemostatic disorders apart from aVWS that may cause bleeding complications [32]. Whether bleeding complications can be reduced with tailored antithrombotic strategies in these vulnerable HS patients, needs further investigation.…”

Section: Discussionmentioning

confidence: 99%

Heyde syndrome: prevalence and outcomes in patients undergoing transcatheter aortic valve implantation

et al. 2021

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Background Heyde syndrome (HS) is known as the association of severe aortic stenosis (AS) and recurrent gastrointestinal bleeding (GIB) from angiodysplasia. Data on the prevalence of HS and results after TAVI remain scarce. Methods 2548 consecutive patients who underwent TAVI for the treatment of AS from 2008 to 2017 were evaluated for a history of GIB and the presence of HS. The diagnosis of HS was defined as a clinical triad of severe AS, a history of recurrent GIB, and an endoscopic diagnosis of angiodysplasia. These patients (Heyde) were followed to investigate clinical outcomes, bleeding complications and the recurrence of GIB and were compared to patients with GIB unrelated to HS (Non-Heyde). Results A history of GIB prior to TAVI was detected in 190 patients (7.5%). Among them, 47 patients were diagnosed with HS (1.8%). Heyde patients required blood transfusions more frequently compared to Non-Heyde patients during index hospitalization (50.0% vs. 31.9%, p = 0.03). Recurrent GIB was detected in 39.8% of Heyde compared to 21.2% of Non-Heyde patients one year after TAVI (p = 0.03). In patients diagnosed with HS and recurrent GIB after TAVI, the rate of residual ≥ mild paravalvular leakage (PVL) was higher compared to those without recurrent bleeding (73.3% vs. 38.1%, p = 0.05). Conclusion A relevant number of patients undergoing TAVI were diagnosed with HS. Recurrent GIB was detected in a significant number of Heyde patients during follow-up. A possible association with residual PVL requires further investigation to improve treatment options and outcomes in patients with HS. Graphic abstract

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Section: Discussionmentioning

confidence: 99%

Heyde syndrome: prevalence and outcomes in patients undergoing transcatheter aortic valve implantation

et al. 2021

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“…Furthermore, there seems to be different hemostatic biology between PCI and TAVR patients. TAVR patients have increased clot time and decreased max thrombin generation in platelet‐rich plasma, compared to acute MI patients undergoing PCI 19 …”

Section: Discussionmentioning

confidence: 99%

Impact of bleeding after transcatheter aortic valve replacement in patients with chronic kidney disease

Patel

Flannery

et al. 2020

Cathet Cardio Intervent

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Objective: In patients with chronic kidney disease (CKD) undergoing transcatheter aortic valve replacement (TAVR), this study aims to elucidate (a) the bleeding risks associated with CKD, (b) the association between bleeding and subsequent mortality, and (c) the pattern of antithrombotic therapy prescribed. Background: Patients with CKD have a higher risk of bleeding following TAVR. It is unclear whether this risk persists beyond the periprocedural period and whether it negatively impacts mortality. Methods: A retrospective review was performed on patients who underwent TAVR at Massachusetts General Hospital from 2008 to 2017. CKD was defined as estimated glomerular filtration rate less than 60 ml/min/1.73 m 2. Primary endpoints up to 1-year following TAVR included bleeding, all-cause mortality, and ischemic stroke. Outcomes for patients with and without CKD were compared using log-rank test, and Cox regression with age, sex, and diabetes as covariates. Bleeding was treated as a time-varying covariate, and Cox proportional hazard regression was utilized to model mortality. Results: Of the 773 patients analyzed, 466 (60.3%) had CKD. At 1 year, CKD patients had higher rates of bleeding (9.2 vs. 4.9%, adjusted hazard ratios [aHR] = 1.91, p = .032) and all-cause mortality (13.7 vs. 9.1%, aHR = 1.57, p = .049), but not stroke (3.9 vs. 1.6% aHR = 0.073, p = .094). Bleeding was associated with an increased risk of subsequent mortality (aHR = 2.65, 95% CI: 1.25-5.63, p = .01). There were no differences in the antithrombotic strategy following TAVR between CKD and non-CKD patients. Conclusion: CKD is associated with a higher risk of bleeding up to 1 year following TAVR. Long-term bleeding after TAVR is associated with increased subsequent mortality.

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“…Specifically, women who received aspirin both before and after TAVI had a higher incidence of major or life-threatening bleeding as compared to men ( 35 ). Several mechanisms have been suggested to account for post-TAVI bleeding, encompassing intrinsic bleeding abnormalities that go beyond the platelet system ( 36 ). These mechanisms may differ from those observed in patients with coronary artery disease who undergo percutaneous coronary intervention, where bleeding issues are also more prevalent in women ( 37 ).…”

Section: Introductionmentioning

confidence: 99%

Sex discrepancies in pathophysiology, presentation, treatment, and outcomes of severe aortic stenosis

Stehli,

Zaman,

Stähli

2023

Front. Cardiovasc. Med.

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This review gives an overview of sex-based differences in aortic valve stenosis, spanning from pathophysiological mechanisms and disease progression, clinical presentation, presence of comorbidities, and diagnostic assessment, to treatment and outcomes. In particular, sex-related differences in the degree of aortic valve calcification, the response of the left ventricle to pressure overload, as well as in the referral to procedures, with women being less frequently referred for surgical aortic valve replacement and experiencing longer waiting times for transcatheter procedures, will be discussed. Sex-related differences are also particularly evident in outcomes of patients with severe aortic stenosis undergoing surgical or transcatheter procedures. The apparent sex paradox seen in women undergoing transcatheter aortic valve implantation refers to the phenomenon of women experiencing higher rates of short-term mortality and bleeding events, but demonstrating improved long-term survival as compared to men. Women who undergo surgical aortic valve replacement have generally worse outcomes as compared to men, which is reflected by the inclusion of female sex in surgical risk calculation scores. Hence, a thorough understanding of sex-related differences in aortic valve stenosis is important to provide optimal and personalized patient care.

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Prolonged Clotting Time Among Patients Undergoing Transcatheter Aortic Valve Replacement

Cited by 5 publications

References 5 publications

Heyde syndrome: prevalence and outcomes in patients undergoing transcatheter aortic valve implantation

Heyde syndrome: prevalence and outcomes in patients undergoing transcatheter aortic valve implantation

Impact of bleeding after transcatheter aortic valve replacement in patients with chronic kidney disease

Sex discrepancies in pathophysiology, presentation, treatment, and outcomes of severe aortic stenosis

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