Incidence, Timing, and Causes of Late Bleeding After TAVR in an Asian Cohort.
JACC Asia
; 2(5): 622-632, 2022 Oct.
Article
en En
| MEDLINE
| ID: mdl-36393917
ABSTRACT
Background:
Data regarding the incidence, predictive factors, and clinical outcomes of post-transcatheter aortic valve replacement (TAVR) bleeding is limited in the Asian cohort.Objectives:
This study sought to assess the predictors and prognostic impact of post-TAVR late bleeding.Methods:
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:
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 (P < 0.001). The multivariate Cox regression analysis revealed that late bleeding, included as a time-varying covariate in the model, was associated with an increased risk of mortality following TAVR (HR 5.63; 95% CI 4.28-7.41; P < 0.001).Conclusions:
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.
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
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Tipo de estudio:
Clinical_trials
/
Etiology_studies
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Incidence_studies
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Prognostic_studies
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Risk_factors_studies
Idioma:
En
Revista:
JACC Asia
Año:
2022
Tipo del documento:
Article
País de afiliación:
Japón