Bleeding Events After Transcatheter Aortic Valve Replacement: JACC State-of-the-Art Review

Transcatheter aortic valve replacement (TAVR) has gained over time a major reduction in procedural complications. Despite this, clinically relevant bleeding still occurs in a non-negligible proportion of patients and adversely affects prognosis. Patients with severe aortic stenosis are at heightened...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2023-02, Vol.81 (7), p.684-702
Main Authors: Avvedimento, Marisa, Nuche, Jorge, Farjat-Pasos, Julio I, Rodés-Cabau, Josep
Format: Article
Language:English
Subjects:
Aortic Valve - surgery
Aortic Valve Stenosis - drug therapy
Aortic Valve Stenosis - surgery
Fibrinolytic Agents - therapeutic use
Hemorrhage - drug therapy
Hemorrhage - epidemiology
Hemorrhage - etiology
Humans
Risk Factors
Transcatheter Aortic Valve Replacement - adverse effects
Treatment Outcome
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Summary:Transcatheter aortic valve replacement (TAVR) has gained over time a major reduction in procedural complications. Despite this, clinically relevant bleeding still occurs in a non-negligible proportion of patients and adversely affects prognosis. 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 define individual bleeding susceptibility. 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. This review aims to provide an in-depth overview of bleeding events in the TAVR field, including definitions, timing and the extent of risk, and clinical impact, as well as updates on antithrombotic management and its potential influence on bleeding complications.
ISSN:1558-3597
DOI:10.1016/j.jacc.2022.11.050