Leaflet thrombosis after TAVI occurred at a pooled incidence of 0.43% per month and significantly increased the risk of stroke (OR 4.21, 95% CI 1.27-13.98).
Meta-Analysis (n=11,124)
Leaflet thrombosis after TAVI is an infrequent event but significantly increases the risk of stroke, highlighting the potential benefit of oral anticoagulation and CT monitoring in high-risk patients.
OBJECTIVES: We examined the incidence, the impact of subsequent cerebrovascular events and the clinical or procedural predictors of leaflet thrombosis (LT) in patients undergoing transcatheter aortic valve implantation (TAVI). METHODS: MEDLINE/PubMed was systematically screened for studies reporting on LT in TAVI patients. Incidence both clinical and subclinical, i.e. detected with computed tomography (CT) of LT was the primary end point of the study. Predictors of LT evaluated at multivariable analysis and impact of LT on stroke were the secondary ones. RESULTS: Eighteen studies encompassing 11 124 patients evaluating incidence of LT were included. Pooled incidence of LT was 0.43% per month 5.16% per year, 95% confidence interval (CI) 0.21-0.72, I2 = 98%. Pooled incidence of subclinical LT was 1.36% per month (16.32% per year, 95% CI 0.71-2.19, I2 = 94%). Clinical LT was less frequent (0.04% per month, 0.48% per year, 95% CI 0.00-0.19, I2 = 93%). LT increased the risk of stroke odds ratio (OR) 4.21, 95% CI 1.27-13.98, and was more frequent in patients with a valve diameter of 28-mm (OR 2.89: 1.55-5.8), for balloon-expandable (OR 8: 2.1-9.7) or after valve-in-valve procedures (OR 17.1: 3.1-84.9). Oral anticoagulation therapy reduced the risk of LT (OR 0.43, 95% CI: 0.22-0.84, I2 = 64%), as well as the mean transvalvular gradient. CONCLUSIONS: LT represents an infrequent event after TAVI, despite increasing risk of stroke. Given its full reversal with warfarin, in high-risk patients (those with valve-in-valve procedures, balloon expandable or large-sized devices), a protocol which includes a control CT appears reasonable.
D’Ascenzo et al. (Tue,) conducted a meta-analysis in Transcatheter aortic valve implantation (TAVI) (n=11,124). Leaflet thrombosis vs. No leaflet thrombosis was evaluated on Incidence (clinical and subclinical) of leaflet thrombosis (95% CI 0.21-0.72). Leaflet thrombosis after TAVI occurred at a pooled incidence of 0.43% per month and significantly increased the risk of stroke (OR 4.21, 95% CI 1.27-13.98).