Primary Hemostatic Disorders and Late Major Bleeding After Transcatheter Aortic Valve Replacement.
J Am Coll Cardiol
; 72(18): 2139-2148, 2018 10 30.
Article
em En
| MEDLINE
| ID: mdl-30360823
ABSTRACT
BACKGROUND:
Periprocedural and late (>30 days) bleedings represent major complications after transcatheter aortic valve replacement and have been identified as potential areas for improved patient care.OBJECTIVES:
The authors sought to evaluate the impact of ongoing primary hemostasis disorders on late major/life-threatening bleeding complications (MLBCs).METHODS:
Bleedings were assessed according to the VARC-2 (Valve Academic Research Consortium-2) criteria. Closure time of adenosine diphosphate (CT-ADP), a surrogate marker of high molecular weight von Willebrand multimers proteolysis was assessed 24 h after the procedure. Ongoing primary hemostasis disorder was defined by a CT-ADP >180 s.RESULTS:
Among 372 patients who survived at 30 days, MLBCs occurred in 42 patients (11.3%) at a median follow-up of 383 days (interquartile range 188 to 574 days). MLBCs were mainly of gastrointestinal origin (42.8%) and were associated with increased overall mortality (hazard ratio [HR] 5.66; 95% confidence interval [CI] 3.10 to 10.31; p < 0.001) and cardiac mortality (HR 11.62; 95% CI 4.59 to 29.37; p < 0.001). A 2.5-fold elevation of MLBCs could be evidenced in patients with a CT-ADP > 180 s (27.4% vs. 11.5%; p < 0.001). Multivariate regression analysis identified paravalvular leak (PVL) (HR 6.31; 95% CI 3.43 to 11.60; p < 0.0001) and CT-ADP > 180 s (HR 3.08; 95% CI 1.62 to 5.81; p = 0.0005) as predictor of MLBCs.CONCLUSIONS:
MLBCs after transcatheter aortic valve replacement are frequent and associated with an increased morbidity and mortality. PVL and CT-ADP >180 s were identified as strong predictors for MLBCs. These findings strongly suggest that persistent HMW defects contribute to enhanced bleeding risk in patients with residual PVL.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Hemorragia Pós-Operatória
/
Transtornos Hemostáticos
/
Substituição da Valva Aórtica Transcateter
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article