Abstract DP054: Intravenous Thrombolysis After Transcatheter Aortic Valve Replacement Does Not Appear to Increase Bleeding Site Complications

Background: Reluctance to offer Intravenous Thrombolysis (IVT) after a procedure may stem from concerns about procedural site bleeding. Periprocedural strokes occur in 1-10% of aortic valve replacements (AVR) like Surgical Aortic Valve Repair (SAVR) and Transfemoral Aortic Valve Repair (TAVR). While reports of IVT after TAVR exist, less is known about nationwide trends in IVT after AVR. We hypothesize that IVT after TAVR does not increase procedural site bleeding and that stroke center volume impacts post-AVR IVT and Endovascular Thrombectomy (EVT) utilization. Methods: We interrogated five consecutive years (2017-2021) of 35 million hospital records in the National Inpatient Sample (NIS). Descriptive statistics were done on ischemic stroke events, IVT, and EVT after OHS, SAVR, and TAVR. Propensity scores were estimated using logistic regression using baseline covariates of sex, age, race, cardiovascular risk factors, hospital factors and IVT/EVT contraindications to account for confounding between OHS and AVR groups. After inverse probability weighting of propensity scores, weighted logistic regression models were used to compare in-hospital mortality, routine discharge, and IVT/EVT utilization. Cross-year hospital files were probabilistically linked by hospital characteristics and surgical volumes. Hospitals were stratified by stroke center volume. Results: 68,829 TAVRs and 55,945 SAVRs were sampled. 1,231 (1.8%) post-TAVR ischemic strokes and 2,006 (3.6%) post-SAVR ischemic strokes were identified. IVT rates after TAVR and SAVR were lower than OHS, but EVT rates were similar (Table 1). High volume stroke centers had the highest rates of ischemic stroke diagnosis and treatment after TAVR (Figure 1). Among TAVR patients, access site bleeding (OR 1.98, p=0.10) and blood transfusion (OR: 0.98, p=1.0) did not differ significantly in IVT vs no IVT. AVR patients receiving IVT had non-significantly lower mortality (OR 0.67, p=0.40) and higher home discharge (OR 1.24, p=0.54). EVT after AVR did not improve mortality (OR Mortality: 1.41, p=0.23) or increase home discharge (OR Discharge Home: 0.81, p=0.52). Conclusions: IVT in post-TAVR stroke occurred more frequently in high volume stroke centers and did not appear to increase bleeding site complications. IVT and EVT in periprocedural TAVR and SAVR strokes did not significantly alter in-hospital mortality or home discharge. Future work should investigate the efficacy of IVT and EVT in periprocedural AVR at 90 days.