Valvular Heart DiseaseMeta-analysis of Predictors of Early Severe Bleeding in Patients Who Underwent Transcatheter Aortic Valve Implantation
Section snippets
Methods
A systematic review of published data on bleeding in patients who underwent TAVI was performed according to recommendation of PRISMA.11 A computerized search was conducted to identify all relevant studies from PubMed and Web of Science databases. The detailed search strategies are shown in the Supplementary Data.
Any study that reported the incidence of SB post-TAVI between 2 groups of patients divided according to the presence/absence of a potential predictor with a sample size >50 were deemed
Results
The PRISMA flow chart was showed in Figure 1. A total of 4,256 records were screened at the title and abstract level, of which 616 full-text articles were retrieved and assessed for eligibility. Finally, 47 studies were deemed eligible for the analysis according to the inclusion and exclusion criteria.
General characteristics of included studies were listed in Table 1. Overall, 65,209 patients were evaluated, with 6,411 patients experienced early SB post-TAVI. The median rate of SB was 11%
Discussion
Lately, 1 meta-analysis of risk factors for post-TAVI bleeding has just been published.23 It focused on any VARC-2 bleeding; however, minor bleeding was less important and may affect the result greatly. Also, factors being evaluated were not comprehensive. Moreover, studies and patients included were quite limited. In contrast, the present study that focused on fatal SB was more comprehensive with much larger population. Our results suggested that 3 patient-related factors (age ≥90, female
Disclosures
The authors have no conflicts of interest to disclose.
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Cited by (21)
Sex Differences in Outcomes After Transcatheter Aortic Valve Replacement: A POPular TAVI Subanalysis
2023, JACC: Cardiovascular InterventionsAntithrombotic Therapy After Transcatheter Aortic Valve Replacement: An Overview
2022, Structural HeartCitation Excerpt :GI complications are most frequently associated with major late bleeding complications.44,45 AF, atrial flutter, diabetes mellitus, frailty (independent of age), anemia, hypertension, and renal impairment are well-known predictors of bleeding post-TAVR.44,46,47 According to the STS/ACC TAVR registry, vascular and bleeding complications were independently associated with an increased 30-day and 1-year mortality and rehospitalization.48
Evolving concepts in the management of antithrombotic therapy in patients undergoing transcatheter aortic valve implantation
2022, European Journal of Internal MedicineCitation Excerpt :Still, vascular access related bleeding accounts for half of all major bleeding events. Non-transfemoral access and sheath diameter have been reported as procedural risk factors [28]. Patient related risk factors include higher age, frailty and frequent comorbidities like renal insufficiency, anaemia and atrial fibrillation [28–32].
Impact of bleeding complications after transcatheter mitral valve repair
2021, IJC Heart and VasculatureCitation Excerpt :However, especially obscure bleeding with a decrease in hemoglobin levels of ≥ 4 g/dl not defined by MVARC were reported to increase mortality [6]. Other risk factors for bleeding, such as age and gender were identified among patients treated with Trans Catheter Aortic Valve (TAVI) repair [7]. Common bleeding scores, designed to quantify bleeding risk in patients with atrial fibrillation (AF), comprise composites of several other known bleeding risk factors [8,9].
Meta-Analysis and Meta-Regression of Transcatheter Aortic Valve Implantation for Pure Native Aortic Regurgitation
2020, Heart Lung and CirculationCitation Excerpt :However, the incidence of LT/M-BC appears to be meaningfully lower after NGD-TAVI for AR (3.5%, present study) than AS (11.6% [24]). The transapical approach has been known to predict a greater (approximately 1.8-fold) incidence of LT/M-BC [29,30], and 57.7% of patients in the present study underwent transapical NGD-TAVI for AR. In the meta-analysis by Barbanti et al. [24], despite far fewer patients (13.9%) undergoing non-transfemoral (mainly transapical) NGD-TAVI for AS, the incidence of LT/M-BC was greater, the reason for which is unclear.
Outcomes of Evolut R Versus CoreValve After Transcatheter Aortic Valve Implantation: A Meta-Analysis
2020, Heart Lung and CirculationCitation Excerpt :There was a trend towards lower risk of severe bleeding in the Evolut R group. Actually, a larger profile has been proven to be a predictor of early severe bleeding after TAVI according to the meta-analysis by Sun et al. [25]; thus, lower risk of severe bleeding could be accounted by lower profile of Evolut R. Periprocedural severe bleeding has been associated with higher short-term and long-term mortality after TAVI [26]. Evolut R may provide long-term survival benefit resulting from less severe bleeding events.
Drs Sun and Liu contributed equally to the manuscript.
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