This review highlights that despite procedural improvements in TAVR, clinically relevant bleeding remains a significant prognostic issue requiring tailored antithrombotic management.
What are the definitions, timing, risk, and clinical impact of bleeding events after TAVR, and how does antithrombotic management influence them?
This review highlights the importance of tailored antithrombotic management and preprocedural evaluation to mitigate the significant risk of bleeding events in patients undergoing TAVR.
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.
“Our study shows that bleeding events are frequent in this population, and not only in [terms of] periprocedural bleeding, which is what we have seen much of the focus on at this point. They can and do occur later on . . . and can potentially be prevented by adjusting the antithrombotic treatment in this elderly and fragile population.”
Avvedimento et al. (2023) conducted a review in Severe aortic stenosis undergoing TAVR. Transcatheter aortic valve replacement (TAVR) was evaluated. This review highlights that despite procedural improvements in TAVR, clinically relevant bleeding remains a significant prognostic issue requiring tailored antithrombotic management.