The following are key points to remember from a state-of the-art review on bleeding events after transcatheter aortic valve replacement (TAVR):

1. TAVR has gained over time an impressive reduction in procedural complications.
2. Despite this, clinically relevant bleeding still occurs in a significant proportion of patients and adversely affects prognosis.
3. Of note, patients with severe aortic stenosis are at heightened risk for spontaneous bleeding due to advanced age and a high comorbidity burden. Also, procedural factors and antithrombotic management contribute to individual bleeding susceptibility.
4. Bleeding prevention represents an emerging area for improving patient care. Because of the tight hemorrhagic/ischemic balance, a tailored approach based on individual bleeding-risk profile, such as a less invasive antithrombotic regimen or appropriate diagnostic preprocedural evaluation, should be pursued to avoid bleeding events.
5. PREDICT-TAVR is a six-item score (blood hemoglobin, serum iron, creatinine clearance, common femoral artery diameter, dual antiplatelet therapy [DAPT], and anticoagulant therapy) showing a high discriminative ability to predict bleeding events within the first 30 days after a procedure.
6. Technical optimization in obtaining vascular access, such as the adoption of ultrasound guidance, should probably be implemented, particularly in specific subgroups of patients at high risk of vascular complications (e.g., small artery size, heavy calcification, higher sheath-to-vessel ratio, severe obesity).
7. Weight-adjusted unfractionated heparin dosage and its reversal with protamine administration represents the most common anticoagulation strategy during the TAVR procedures.
8. Although evidence and current guidelines support an antiplatelet monotherapy approach over DAPT after TAVR, whether aspirin or an oral P2Y12 inhibitor should be used remains a matter of debate.
9. Single antiplatelet therapy seems to be an effective and safer therapeutic approach in TAVR patients with no indication for anticoagulation, while oral anticoagulation (OAC) alone is a reasonable strategy for those with chronic indications for OAC.
10. Finally, future studies focused on bleeding preventive strategies are warranted to further enhance the safety profile of TAVR and the patient’s prognosis.

Clinical Topics: Anticoagulation Management, Cardiac Surgery, Geriatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and VHD, Interventions and Imaging, Interventions and Structural Heart Disease, Echocardiography/Ultrasound

Keywords: Anticoagulants, Aortic Valve Stenosis, Aspirin, Comorbidity, Cardiac Surgical Procedures, Creatinine, Fibrinolytic Agents, Geriatrics, Heart Valve Diseases, Hemoglobins, Hemorrhage, Heparin, Platelet Aggregation Inhibitors, Secondary Prevention, Transcatheter Aortic Valve Replacement, Ultrasonography, Interventional, Vascular Diseases

< Back to Listings