Transcatheter aortic valve thrombosis: Data from a French multicenter cohort analysis

Abstract

Objectives To evaluate the effectiveness of anticoagulant therapies in patients with clinical transcatheter heart valve (THV) thrombosis, to describe complications, and to assess their risk profile was the objectives. Background Little research has been conducted on clinical THV thrombosis. Methods Patients with clinical THV thrombosis were identified based on greater than 50% increased transvalvular gradient on transthoracic echocardiogram confirmed by 4‐dimensional computed tomography, transesophageal echocardiogram, or regression with anticoagulant therapy. A cohort free from thrombosis for more than 1,100 days postprocedure was used for comparison. Results Fifty‐four patients with clinical THV thrombosis were identified. Most subjects (98.1%) received anticoagulant therapy which was effective (≥50% reduction in transvalvular gradient or return to postprocedure value) in 96%. The rate of serious hemodynamic or embolic complications in the thrombosis population was 31.5%. A multivariate analysis of subjects with and without thrombosis indicated a significantly increased risk of thrombosis from preexisting thrombocytopenia (odds ratio [OR] 9.96), absence of predilatation (OR = 5.67), renal insufficiency (OR = 4.84), and >10 mmHg mean transvalvular gradient postprocedure (OR = 3.36). No recurrence of thrombosis was identified during on average 685 days follow‐up. Conclusions These data, from one of the largest cohorts with clinical THV thrombosis confirm anticoagulants appear effective. The rate of serious associated complications was high. The findings underline the importance of recognizing risk factors for thrombosis.

Direct oral anticoagulant versus antiplatelet therapy following transcatheter aortic valve replacement in patients without prior or concurrent indication for anticoagulation: A meta‐analysis of randomized studies

“…meta-analysis addresses this question, confirming the findings of a significantly higher risk of valve thrombosis in the antiplatelet group (3.2%) as compared with the DOACs group (0.8%). Similarly, a previous multicenter cohort analysis by Mouyen et al4 reported a ≥50% reduction in transvalvular gradient in 96% of patients with transcatheter heart valve clinical thrombosis who were treated with anticoagulation therapy. In our study, the reduction in obstructive valve thrombosis incidence in the DOACs group, however, did not reflect in a significant difference in ischemic stroke incidence between the groups (RR: 1.28; 95% CI: 0.76−2.15; p = 0.35).…”

“…3 The postprocedure antithrombotic management in these patients remains a source of controversy and debate, particularly in patients who do not have a preexisting comorbidity that requires long-term anticoagulation therapy. 4,5 A number of robust clinical trials have been conducted with the goal of establishing the ideal antithrombotic therapy in this specific population. [6][7][8] However, these trials were powered for composite endpoints, not for individual outcomes, such as cardiovascular mortality or major bleeding.…”

“…However, patients who undergo TAVR are at risk for ischemic and hemorrhagic events, which can have a major impact on short‐term survival 3 . The postprocedure antithrombotic management in these patients remains a source of controversy and debate, particularly in patients who do not have a preexisting comorbidity that requires long‐term anticoagulation therapy 4,5 . A number of robust clinical trials have been conducted with the goal of establishing the ideal antithrombotic therapy in this specific population 6–8 .…”

Transcatheter aortic valve thrombosis: The more we see the more we know

“…One case of fatal bleeding was reported. Obesity, pre‐existing thrombocytopenia, absence of predilation, renal failure, and high gradient (>10 mm Hg) immediately after the procedure were identified as main predictors of clinically relevant valve thrombosis 4 …”