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For: Salinas P, Moreno R, Sanchez-Recalde A, Jimenez-Valero S, Galeote G, Calvo L, Plaza I, Lopez-Sendon J. Does New Onset Atrial Fibrillation Have a True Impact on the Incidence of Stroke After Transcatheter Aortic Valve Implantation? J Am Coll Cardiol 2012;60:236-7; author reply 238. [DOI: 10.1016/j.jacc.2012.02.063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 02/12/2012] [Indexed: 10/28/2022]

For:	Salinas P, Moreno R, Sanchez-Recalde A, Jimenez-Valero S, Galeote G, Calvo L, Plaza I, Lopez-Sendon J. Does New Onset Atrial Fibrillation Have a True Impact on the Incidence of Stroke After Transcatheter Aortic Valve Implantation? J Am Coll Cardiol 2012;60:236-7; author reply 238. [DOI: 10.1016/j.jacc.2012.02.063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 02/12/2012] [Indexed: 10/28/2022]

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Cited by Other Article(s)

Dietrich L, Kibler M, Matsushita K, Marchandot B, Trimaille A, Reydel A, Diop B, Truong PD, Trung AM, Trinh A, Carmona A, Hess S, Jesel L, Ohlmann P, Morel O. Impact of Primary Hemostasis Disorders on Late Major Bleeding Events among Anticoagulated Atrial Fibrillation Patients Treated by TAVR. J Clin Med 2021;11:212. [PMID: 35011952 PMCID: PMC8746148 DOI: 10.3390/jcm11010212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/21/2021] [Accepted: 12/29/2021] [Indexed: 11/16/2022] Open

Abstract

BACKGROUND

Bleeding events are among the striking complications following transcatheter aortic valve replacement (TAVR), and bleeding prediction models are crucially warranted. Several studies have highlighted that primary hemostasis disorders secondary to persistent loss of high-molecular-weight (HMW) multimers of the von Willebrand factor (vWF) and assessed by adenosine diphosphate closure time (CT-ADP) may be a strong predictor of late major/life-threatening bleeding complications (MLBCs). Pre-existing atrial fibrillation (AF) is a frequent comorbidity in TAVR patients and potentially associated with increased bleeding events after the procedure.

OBJECTIVES

This study evaluated the impact of ongoing primary hemostasis disorders, as assessed by post-procedural CT-ADP > 180 s, on clinical events after TAVR among anticoagulated AF patients.

METHODS

An ongoing primary hemostasis disorder was defined by post-procedure CT-ADP > 180 s. Bleeding complications were assessed according to the Valve Academic Research Consortium-2 (VARC-2) criteria. The primary endpoint was the occurrence of late MLBCs at one-year follow-up. The secondary endpoint was a composite of mortality, stroke, myocardial infarction, and rehospitalization for heart failure.

RESULTS

In total, 384 TAVR patients were included in the analysis. Of these patients, 57 patients (14.8%) had a prolongated CT-ADP > 180 s. Increased MLBCs were observed in patients with CT-ADP > 180 s (35.1% versus 1.2%; p < 0.0001). Conversely, the occurrence of the composite endpoint did not differ between the groups. Multivariate analysis identified CT-ADP > 180 s (HR 28.93; 95% CI 9.74-85.95; p < 0.0001), bleeding history, paradoxical aortic stenosis (AS), and major vascular complications following TAVR as independent predictors of late MLBCs.

CONCLUSION

Among patients with anticoagulated AF, a post-procedural CT-ADP > 180 s was identified as a strong independent predictor of late MLBCs. These findings suggest that persistent primary hemostasis disorders contribute to a higher risk of late bleeding events and should be considered for a tailored, risk-adjusted antithrombotic therapy after TAVR.

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Affiliation(s)

Laurent Dietrich Centre Hospitalier Universitaire, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Université de Strasbourg, 67000 Strasbourg, France; (L.D.); (K.M.); (B.M.); (A.T.); (A.R.); (B.D.); (A.T.); (A.C.); (S.H.); (L.J.); (P.O.); (O.M.)
Marion Kibler Centre Hospitalier Universitaire, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Université de Strasbourg, 67000 Strasbourg, France; (L.D.); (K.M.); (B.M.); (A.T.); (A.R.); (B.D.); (A.T.); (A.C.); (S.H.); (L.J.); (P.O.); (O.M.)
Kensuke Matsushita Centre Hospitalier Universitaire, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Université de Strasbourg, 67000 Strasbourg, France; (L.D.); (K.M.); (B.M.); (A.T.); (A.R.); (B.D.); (A.T.); (A.C.); (S.H.); (L.J.); (P.O.); (O.M.) Institut National de la Santé et de la Recherche Médicale (INSERM), Nano Médecine Régénérative, Unité Mixte de Recherche 1260, Faculté de Pharmacie, Université de Strasbourg, 67400 Illkirch, France
Benjamin Marchandot Centre Hospitalier Universitaire, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Université de Strasbourg, 67000 Strasbourg, France; (L.D.); (K.M.); (B.M.); (A.T.); (A.R.); (B.D.); (A.T.); (A.C.); (S.H.); (L.J.); (P.O.); (O.M.)
Antonin Trimaille Centre Hospitalier Universitaire, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Université de Strasbourg, 67000 Strasbourg, France; (L.D.); (K.M.); (B.M.); (A.T.); (A.R.); (B.D.); (A.T.); (A.C.); (S.H.); (L.J.); (P.O.); (O.M.)
Antje Reydel Centre Hospitalier Universitaire, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Université de Strasbourg, 67000 Strasbourg, France; (L.D.); (K.M.); (B.M.); (A.T.); (A.R.); (B.D.); (A.T.); (A.C.); (S.H.); (L.J.); (P.O.); (O.M.)
Bamba Diop Centre Hospitalier Universitaire, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Université de Strasbourg, 67000 Strasbourg, France; (L.D.); (K.M.); (B.M.); (A.T.); (A.R.); (B.D.); (A.T.); (A.C.); (S.H.); (L.J.); (P.O.); (O.M.)
Phi Dinh Truong Vietnam National Heart Institute, Bach Mai Hospital, Hanoi 100000, Vietnam; (P.D.T.); (A.M.T.)
Anh Mai Trung Vietnam National Heart Institute, Bach Mai Hospital, Hanoi 100000, Vietnam; (P.D.T.); (A.M.T.)
Annie Trinh Centre Hospitalier Universitaire, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Université de Strasbourg, 67000 Strasbourg, France; (L.D.); (K.M.); (B.M.); (A.T.); (A.R.); (B.D.); (A.T.); (A.C.); (S.H.); (L.J.); (P.O.); (O.M.)
Adrien Carmona Centre Hospitalier Universitaire, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Université de Strasbourg, 67000 Strasbourg, France; (L.D.); (K.M.); (B.M.); (A.T.); (A.R.); (B.D.); (A.T.); (A.C.); (S.H.); (L.J.); (P.O.); (O.M.)
Sébastien Hess Centre Hospitalier Universitaire, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Université de Strasbourg, 67000 Strasbourg, France; (L.D.); (K.M.); (B.M.); (A.T.); (A.R.); (B.D.); (A.T.); (A.C.); (S.H.); (L.J.); (P.O.); (O.M.)
Laurence Jesel Centre Hospitalier Universitaire, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Université de Strasbourg, 67000 Strasbourg, France; (L.D.); (K.M.); (B.M.); (A.T.); (A.R.); (B.D.); (A.T.); (A.C.); (S.H.); (L.J.); (P.O.); (O.M.) Institut National de la Santé et de la Recherche Médicale (INSERM), Nano Médecine Régénérative, Unité Mixte de Recherche 1260, Faculté de Pharmacie, Université de Strasbourg, 67400 Illkirch, France
Patrick Ohlmann Centre Hospitalier Universitaire, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Université de Strasbourg, 67000 Strasbourg, France; (L.D.); (K.M.); (B.M.); (A.T.); (A.R.); (B.D.); (A.T.); (A.C.); (S.H.); (L.J.); (P.O.); (O.M.)
Olivier Morel Centre Hospitalier Universitaire, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Université de Strasbourg, 67000 Strasbourg, France; (L.D.); (K.M.); (B.M.); (A.T.); (A.R.); (B.D.); (A.T.); (A.C.); (S.H.); (L.J.); (P.O.); (O.M.) Institut National de la Santé et de la Recherche Médicale (INSERM), Nano Médecine Régénérative, Unité Mixte de Recherche 1260, Faculté de Pharmacie, Université de Strasbourg, 67400 Illkirch, France

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Ammar A, Elbatran AI, Wijesuriya N, Saberwal B, Ahsan SY. Management of atrial fibrillation after transcatheter aortic valve replacement: Challenges and therapeutic considerations. Trends Cardiovasc Med 2020;31:361-367. [PMID: 32599334 DOI: 10.1016/j.tcm.2020.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 12/20/2022]

Tarantini G, Mojoli M, Urena M, Vahanian A. Atrial fibrillation in patients undergoing transcatheter aortic valve implantation: epidemiology, timing, predictors, and outcome. Eur Heart J 2018;38:1285-1293. [PMID: 27744287 DOI: 10.1093/eurheartj/ehw456] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/11/2016] [Indexed: 12/31/2022] Open

Arroyo-Úcar E, Moreno R, del Prado S, López T, Sánchez-Recalde A, Calvo Orbe L, Jiménez-Valero S, Galeote G, Ramírez MU, Gonzalez Davia R, Plaza I, Mesa JM, López-Sendón JL. Echogenic mobile images in intraprocedural three-dimensional transesophageal echocardiographic monitoring during percutaneous aortic valve implantation: Incidence, characteristics and clinical implications. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2015.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open

Echogenic mobile images in intraprocedural three-dimensional transesophageal echocardiographic monitoring during percutaneous aortic valve implantation: Incidence, characteristics and clinical implications. Rev Port Cardiol 2016;35:133-8. [PMID: 26919889 DOI: 10.1016/j.repc.2015.09.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 09/13/2015] [Indexed: 11/22/2022] Open

Barbash IM, Minha S, Ben-Dor I, Dvir D, Torguson R, Aly M, Bond E, Satler LF, Pichard AD, Waksman R. Predictors and clinical implications of atrial fibrillation in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2014;85:468-77. [DOI: 10.1002/ccd.25708] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 10/10/2014] [Indexed: 11/11/2022]