Key result
Mechanical AVR most commonly links to gastrointestinal bleeding, affecting ~9% of patients long-term.
Why the study?
Mechanical aortic valve prostheses require life-long anticoagulation, increasing bleeding risk, but the specific types of bleeding complications following mechanical AVR are not well known.
What are the types and frequencies of major bleeding events in patients following mechanical aortic valve replacement?
What are the types and frequencies of major bleeding events in patients following mechanical aortic valve replacement?
Gastrointestinal and intracranial bleeding account for the majority of major bleeding complications following mechanical aortic valve replacement, highlighting the need for targeted bleeding reduction strategies.
Bleeding patterns after mechanical AVR highlight surveillance needs; observational data leaves targeted mitigation open for randomized trials.
OBJECTIVES Mechanical aortic valve prostheses have long durability but require life-long anticoagulation, which increases the risk of bleeding. However, the types of bleeding complications following mechanical aortic valve replacement (AVR) are not well known. Therefore, we conducted this study to investigate various types of bleeding following mechanical AVR. METHODS In this nationwide, observational cohort study all patients who underwent mechanical AVR in Sweden between 1997 to 2022 were included. Patients were identified using the SWEDEHEART registry. The primary outcome was types of first major bleeding event that required hospitalization following mechanical AVR. These outcomes were obtained from the Swedish National Patient Register based on International Classification of Diseases (ICD) codes. RESULTS In total, 13 508 patients underwent mechanical AVR. Of these, 2029 patients (15%) had a major bleeding event. The mean age was 58 years (95% CI, 57.9–58.3) and 29% were females. Bleeding complications included gastrointestinal bleeding (40%), intracranial bleeding (24%), hematuria (15%), epistaxis (13%), bleeding-induced anemia (5.4%), airway bleeding (1.6%), and hemopericardium/haemothorax (1.3%). At 20 years, the cumulative incidences of gastrointestinal and intracranial bleeding were 9.0% (95% CI, 8.4–9.6%) and 5.3% (95% CI, 4.8–5.8%). CONCLUSIONS Gastrointestinal and intracranial bleeding account for the majority of bleeding complications following mechanical AVR, followed by hematuria and epistaxis. Future studies on strategies to reduce bleeding complications in this population are needed.
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Lu et al. (2026) studied this question. Gastrointestinal and intracranial bleeding were the most common bleeding complications post-mechanical aortic valve replacement, occurring in 9.0% and 5.3% of patients at 20 years, respectively.
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