Incidence, Timing, and Causes of Late Bleeding After TAVR in an Asian Cohort.
AF, atrial fibrillation
BARC, Bleeding Academic Research Consortium
CFS, clinical frailty scale
DAPT, dual antiplatelet therapy
GI, gastrointestinal
NYHA, New York Heart Association
OAC, oral anticoagulant
OR, odds ratio
PCI, percutaneous coronary intervention
SPAT, single antiplatelet therapy
TAVR, transcatheter aortic valve replacement
clinical outcome
late bleeding
transcatheter aortic valve replacement
Journal
JACC. Asia
ISSN: 2772-3747
Titre abrégé: JACC Asia
Pays: United States
ID NLM: 9918452380106676
Informations de publication
Date de publication:
Oct 2022
Oct 2022
Historique:
received:
27
08
2021
revised:
05
04
2022
accepted:
26
04
2022
entrez:
17
11
2022
pubmed:
18
11
2022
medline:
18
11
2022
Statut:
epublish
Résumé
Data regarding the incidence, predictive factors, and clinical outcomes of post-transcatheter aortic valve replacement (TAVR) bleeding is limited in the Asian cohort. This study sought to assess the predictors and prognostic impact of post-TAVR late bleeding. This study used the Japanese multicenter registry data to analyze 2,518 patients (mean age: 84.3 ± 5.2 years) who underwent TAVR. Late bleeding was defined as any postdischarge bleeding events after TAVR. Baseline characteristics, predictive factors, and clinical outcomes including death and rehospitalization were assessed in patients with and without late bleeding events. The cumulative incidence rate of all and major late bleeding and ischemic stroke were 7.4%, 5.2%, and 3.4%, respectively, 3 years after TAVR. The independent predictive factors of late bleeding were low platelet count, high score (≥4) on the clinical frailty scale, and a New York Heart Association functional class III/IV. The cumulative mortality rates up to 3 years were significantly higher in patients with late bleeding than in those without bleeding ( Late bleeding after TAVR was not a rare complication, and it significantly increased long-term mortality. It should be carefully managed, especially when it is predictable in the high-risk cohort, and efforts should be taken to reduce bleeding complications even after a successful procedure.
Sections du résumé
Background
UNASSIGNED
Data regarding the incidence, predictive factors, and clinical outcomes of post-transcatheter aortic valve replacement (TAVR) bleeding is limited in the Asian cohort.
Objectives
UNASSIGNED
This study sought to assess the predictors and prognostic impact of post-TAVR late bleeding.
Methods
UNASSIGNED
This study used the Japanese multicenter registry data to analyze 2,518 patients (mean age: 84.3 ± 5.2 years) who underwent TAVR. Late bleeding was defined as any postdischarge bleeding events after TAVR. Baseline characteristics, predictive factors, and clinical outcomes including death and rehospitalization were assessed in patients with and without late bleeding events.
Results
UNASSIGNED
The cumulative incidence rate of all and major late bleeding and ischemic stroke were 7.4%, 5.2%, and 3.4%, respectively, 3 years after TAVR. The independent predictive factors of late bleeding were low platelet count, high score (≥4) on the clinical frailty scale, and a New York Heart Association functional class III/IV. The cumulative mortality rates up to 3 years were significantly higher in patients with late bleeding than in those without bleeding (
Conclusions
UNASSIGNED
Late bleeding after TAVR was not a rare complication, and it significantly increased long-term mortality. It should be carefully managed, especially when it is predictable in the high-risk cohort, and efforts should be taken to reduce bleeding complications even after a successful procedure.
Identifiants
pubmed: 36393917
doi: 10.1016/j.jacasi.2022.04.007
pii: S2772-3747(22)00124-7
pmc: PMC9660329
doi:
Types de publication
Journal Article
Langues
eng
Pagination
622-632Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2022 The Authors.
Déclaration de conflit d'intérêts
The OCEAN-TAVI registry is supported by Edwards Lifesciences, Medtronic, Boston Scientific, Abbott Medical, and Daiichi-Sankyo Company. Drs Yamamoto, Tada, Naganuma, Shirai, Mizutani, Tabata, Ueno, Watanabe, and Hayashida are clinical proctors for Edwards Lifesciences and Medtronic. Drs Koyama and Takagi are clinical proctors of Edwards Lifesciences. Dr Yashima is a clinical proctor for Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Références
N Engl J Med. 2016 Apr 28;374(17):1609-20
pubmed: 27040324
N Engl J Med. 2019 May 2;380(18):1695-1705
pubmed: 30883058
Thromb Haemost. 2018 Nov;118(11):1997-2005
pubmed: 30312975
Chest. 2010 Nov;138(5):1093-100
pubmed: 20299623
Age Ageing. 2017 Sep 1;46(5):709-712
pubmed: 28338866
J Am Coll Cardiol. 2018 Oct 30;72(18):2139-2148
pubmed: 30360823
N Engl J Med. 2020 Jan 9;382(2):120-129
pubmed: 31733180
JACC Cardiovasc Interv. 2016 Jul 25;9(14):1450-7
pubmed: 27372190
N Engl J Med. 2019 Sep 19;381(12):1103-1113
pubmed: 31475793
Circulation. 2011 Jun 14;123(23):2736-47
pubmed: 21670242
N Engl J Med. 2011 Jun 9;364(23):2187-98
pubmed: 21639811
Eur Heart J. 2012 Oct;33(19):2403-18
pubmed: 23026477
J Am Coll Cardiol. 2015 Sep 1;66(9):1036-45
pubmed: 26314532
EuroIntervention. 2017 Mar 20;12(16):1954-1961
pubmed: 27746402
Circ Cardiovasc Interv. 2016 Jun;9(6):
pubmed: 27301394
Int J Cardiol. 2018 Mar 1;254:10-15
pubmed: 29407077
N Engl J Med. 2020 Oct 8;383(15):1447-1457
pubmed: 32865376
JACC Cardiovasc Interv. 2016 Jul 11;9(13):1349-57
pubmed: 27388822
J Am Coll Cardiol. 2014 Dec 23;64(24):2605-2615
pubmed: 25524339
Circ Cardiovasc Interv. 2017 Sep;10(9):
pubmed: 28916601
Circulation. 2017 May 23;135(21):2013-2024
pubmed: 28302751
Curr Opin Crit Care. 2015 Dec;21(6):520-6
pubmed: 26539925
Eur Heart J. 2010 May;31(10):1257-65
pubmed: 20181681
Cardiovasc Revasc Med. 2019 Oct;20(10):843-851
pubmed: 30553819
J Am Coll Cardiol. 2015 Apr 14;65(14):1411-20
pubmed: 25857906
N Engl J Med. 2017 Oct 19;377(16):1513-1524
pubmed: 28844193
J Thromb Haemost. 2010 Jun;8(6):1216-22
pubmed: 20345727
Lancet. 2018 Mar 31;391(10127):1274-1284
pubmed: 29544699