Impact of bleeding after transcatheter aortic valve replacement in patients with chronic kidney disease

Abstract

Objective: In patients with chronic kidney disease (CKD) undergoing transcatheter aortic valve replacement (TAVR), this study aims to elucidate (a) the bleeding risks associated with CKD, (b) the association between bleeding and subsequent mortality, and (c) the pattern of antithrombotic therapy prescribed. Background: Patients with CKD have a higher risk of bleeding following TAVR. It is unclear whether this risk persists beyond the periprocedural period and whether it negatively impacts mortality. Methods: A retrospective review was performed on patients who underwent TAVR at Massachusetts General Hospital from 2008 to 2017. CKD was defined as estimated glomerular filtration rate less than 60 ml/min/1.73 m 2. Primary endpoints up to 1-year following TAVR included bleeding, all-cause mortality, and ischemic stroke. Outcomes for patients with and without CKD were compared using log-rank test, and Cox regression with age, sex, and diabetes as covariates. Bleeding was treated as a time-varying covariate, and Cox proportional hazard regression was utilized to model mortality. Results: Of the 773 patients analyzed, 466 (60.3%) had CKD. At 1 year, CKD patients had higher rates of bleeding (9.2 vs. 4.9%, adjusted hazard ratios [aHR] = 1.91, p = .032) and all-cause mortality (13.7 vs. 9.1%, aHR = 1.57, p = .049), but not stroke (3.9 vs. 1.6% aHR = 0.073, p = .094). Bleeding was associated with an increased risk of subsequent mortality (aHR = 2.65, 95% CI: 1.25-5.63, p = .01). There were no differences in the antithrombotic strategy following TAVR between CKD and non-CKD patients. Conclusion: CKD is associated with a higher risk of bleeding up to 1 year following TAVR. Long-term bleeding after TAVR is associated with increased subsequent mortality.

In-Hospital Outcomes of Transcatheter Aortic Valve Replacement in Patients with Chronic and End-Stage Renal Disease: A Nationwide Database Study

“…Vascular access complications in our cohort were slightly more common in patients with CKD or ESRD (aOR 1.2 and 1.3, respectively). Prior studies have consistently reported more bleeding and vascular access complications in patients with renal insu ciency, compared to the general population [4,5,8,9,11,12,23,24], including recent meta-analyses [7,10]. These complications are a result of uremic toxins and morphologic changes in the vessel wall, which lead to dysfunction of the coagulation cascade [31].…”

“…Chronic kidney disease (CKD) is a common comorbidity in patients with aortic stenosis and an independent risk factor for mortality in those undergoing transcatheter aortic valve replacement (TAVR) [1][2][3][4][5][6]. In addition to higher short-and long-term mortality, CKD confers a higher risk of vascular access complications and major bleeding after TAVR [5,[7][8][9]. This risk increases with the severity of renal insu ciency [2,[6][7][8]10].…”

Evaluation and Management of Aortic Stenosis in Chronic Kidney Disease: A Scientific Statement From the American Heart Association

“…195 In a single-center study of patients undergoing TAVR, despite comparable antithrombotic regimens, patients with CKD had a significantly higher risk of bleeding at 1 year compared with those without CKD (9.2% versus 4.9%; P =0.32). 196 Bleeding in turn was associated with a nearly 2.5-fold higher hazard of subsequent mortality. Current guidelines recommend that anticoagulation with VKA to achieve an international normalized ratio of 2.5 may be reasonable for at least 3 months in patients at low risk of bleeding, but it is unclear whether this can be applied universally in all patients with CKD G4 to G5D.…”

Impact of Chronic Kidney Disease on the Prognosis of Transcatheter Aortic Valve Replacement in Patients with Aortic Stenosis: A Meta-Analysis of 133624 Patients

“…Finally, 20 articles, with a total of 133624 patients, fulfilled the inclusion criteria and were selected for analysis. [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]…”