Predictors of late bleeding in the tavr population
Abdelrahim E, Eng M, Gorgis S, Mawri S, Wang DD, Greenbaum A, Mahan M, Wyman J, Paone G, O'Neill W. Predictors of late bleeding in the tavr population. J Am Coll Cardiol. Mar 2017;69(11):1298-1298.
J Am Coll Cardiol
Background: TAVR patients are often elderly with multiple comorbidities increasing their susceptibility to latebleeding. Post-TAVR anticoagulation is without data for guidance. To provide insight, the relationships between latebleeding, comorbidities and discharge medications were assesed. Methods: Using a single center prospective database, we analyzed 500 consecutive TAVR patients. Bleeding events were classified according to VARC2 and BARC definitions. Clinical variables and discharge medications were compared in patients with and without bleeding. T-test and Chi-square were used to compare continuous and categorical variables respectively. Univariate logistic regression calculated odds ratios. Results: Clinical variables, discharge medications and bleeding are described in Table 1. Mean time to bleedingevents and follow up time were 14 ± 11.2 and 16.9 ± 12.7 months respectively. Thirty patients suffered VARC2/BARC3 bleeding (6%) within 1 year. Of 65 VARC2 major bleeds, most were gastrointestinal (n=40) in nature. Patients with prior bleeding [OR 2.17 CI 1.23-3.84] and dual-antiplatelet therapy (DAPT) [OR 1.91 CI 1.06-3.45] have increased odds for VARC major/life threatening bleeding . High HASBLED scores were not associated with bleeding[OR 1.13 CI 0.85-1.50]. Conclusions: Significant rates of late bleeding were observed. Prior history of bleeding and DAPT were predictors of late bleeding. This bears significant implications for prosthetic valve thromboprophylaxis . (Table presented).