Impact of HAS‐BLED score to predict trans femoral transcatheter aortic valve replacement outcomes

Honda, Yohsuke; Yamawaki, Masahiro; Araki, Motoharu; Tada, Norio; Naganuma, Toru; Yamanaka, Futoshi; Watanabe, Yusuke; Yamamoto, Masanori; Shirai, Shinichi; Hayashida, Kentaro; Investigators, Ocean-Tavi

doi:10.1002/ccd.27596

Cited by 17 publications

(10 citation statements)

References 23 publications

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“…This study demonstrates that the risk of CVE following TAVR is associated with (A) calcification burden of the device landing zone, namely, the RCC as a surrogate parameter of the aortic valve, LVOT, and ascending aorta calcification burden; (B) higher mechanical forces during the implantation process, caused by larger aortic angulation, snaring, and residual aortic regurgitation; and (C) lack of post-procedural dual antithrombotic or anticoagulation treatment. Our developed risk model was superior to both established risk scores for outcome prediction (EuroSCORE II and STS score) mentioned in the current guidelines [1], as well as the risk scores examined for CVE prediction after TAVR in previous studies (CHA 2 DS 2 -VASc score and HAS-BLED score) [9,10]. Nevertheless, the reliability of CVE prediction is limited due to the infrequency of this event.…”

Section: Discussionmentioning

confidence: 74%

Cerebrovascular Events after Transcatheter Aortic Valve Replacement: The Difficulty in Predicting the Unpredictable

Maier

Bosbach²,

Piayda³

et al. 2022

JCM

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Background: Cerebrovascular events (CVE) are feared complications following transcatheter aortic valve replacement (TAVR). We aimed to develop a new risk model for CVE prediction with the application of multimodal imaging. Methods: From May 2011 to August 2019, a total of 2015 patients underwent TAVR at our institution. The study cohort was subdivided into a derivation cohort (n = 1365) and a validation cohort (n = 650) for risk model development. Results: Of 2015 patients, 72 (3.6%) developed TAVR-related CVE. Pre-procedural factors of our risk model were history of prior CVE, a larger aortic valve area (≥0.55 cm2), a large aortic angulation (≥48.5°), and enhanced calcification of the right coronary cusp (≥447.2 AU), left ventricular outflow tract (≥262.4 AU), and ascending thoracic aorta (≥116.4 AU). Our risk model was superior for in-hospital CVE prediction following TAVR in the establishment cohort (AUC 0.73, 95% CI 0.66–0.80; p < 0.001) compared to other risk scores, such as the EuroSCORE II or the CHA2DS2-VASc score. Conclusions: Although CVE prediction in patients undergoing TAVR is challenging due to the complex nature of the TAVR procedure, our study highlights that multimodal imaging is a promising approach to generate a more accurate risk model for CVE prediction.

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Section: Discussionmentioning

confidence: 74%

Cerebrovascular Events after Transcatheter Aortic Valve Replacement: The Difficulty in Predicting the Unpredictable

Maier

Bosbach²,

Piayda³

et al. 2022

JCM

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“…In the pivotal trials for patients with low or intermediate surgical risks, the incidences of serious bleeding events for 1 year ranged between 3.2% and 15.2% 17–19. Moreover, that was 18.2% in a prospective registry20 and the incidence of bleeding events was low in this study. Bleeding events often include the drop of haemoglobin in the endpoint definition of TAVR trials, but it was not included in this study, because whether it is obvious that bleeding was unknown in this registry data.…”

Section: Discussionmentioning

confidence: 52%

Modified percutaneous coronary intervention-derived risk models (PARIS and CREDO-Kyoto integer scoring systems) applied to Japanese transcatheter aortic valve replacement patients

Ohya

Kohsaka

Kumamaru³

et al. 2023

Open Heart

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ObjectivePostprocedural ischaemic and bleeding risks after transcatheter aortic valve replacement (TAVR) remain a major concern. Nevertheless, no reliable risk models incorporating both possibilities are currently available. We aimed to assess the accuracy of percutaneous coronary intervention (PCI)-derived models and the performance of a recalibrated model that included variables more applicable to TAVR.MethodsThis study included 26 869 patients who had been enrolled in a national registry. Ischaemic events were defined as myocardial infarction, stroke, transient ischaemic attack or peripheral embolism at 1 year. Bleeding events were defined as any bleeding based on the Valve Academic Research Consortium-2 consensus document at 1 year. Patterns of Non-adherence to Anti-Platelet Regimen in Stented Patients (PARIS) and Coronary Revascularisation Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) integer scoring systems were tested. The models were recalibrated by applying new variables using the Fine and Gray method.ResultsThe 1-year cumulative incidences for ischaemic and bleeding events were 2.7% and 3.1%. Patients with high PARIS and CREDO-Kyoto risk scores had higher incidences of both ischaemic (3.3% vs 2.4% vs 2.4%, p<0.001 and 2.8% vs 2.0% vs 0.8%, p<0.001) and bleeding events (3.3% vs 2.5% vs 0.8%, p<0.001 and 3.7% vs 3.0% vs 2.4%, p<0.001) when compared with intermediate and low-risk patients. The receiver operating characteristic area under the curves for these models were 0.53, 0.58, 0.56 and 0.55, respectively. After the models were recalibrated to incorporate variables more applicable to TAVR, the performance of ischaemic and bleeding models modestly improved (0.58 and 0.61, respectively).ConclusionsThe PCI-derived models demonstrated modest accuracy but was inadequate for risk stratification of TAVR patients at 1-year follow-up.Trial registration number3395.

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“…The European guidelines do indicate that SAPT may be considered after TAVR in patients at high bleeding risk (class IIb; level of evidence: C) . While no specific threshold is recommended, a HAS-BLED score of 4 points or more was considered high bleeding risk in 1 study, whereas a HAS-BLED score of 3 points or more is generally used to indicate high bleeding risk in the context of AF or coronary interventions. In clinical practice, the Society for Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry reported that of 16 694 patients, 13 546 (81.1%) with no indication for OACs were discharged while taking DAPT after TAVR between 2011 and 2016, whereas 3148 patients (18.9%) were while taking SAPT, with significant variation among hospitals (data not provided) .…”

Section: Antithrombotic Therapy Studies In Tavrmentioning

confidence: 99%

Adjunctive Antithrombotic Therapy for Patients With Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

et al. 2020

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IMPORTANCETranscatheter aortic valve replacement (TAVR) is an established alternative to surgery for patients with severe symptomatic aortic stenosis. Adjunctive antithrombotic therapy used to mitigate thrombotic risks in patients undergoing TAVR must be balanced against bleeding complications, since both are associated with increased mortality.OBSERVATION Stroke risk associated with TAVR is lower than that associated with surgical aortic valve replacement in recent trials including patients at intermediate or low risk, but it is constant beginning at the time of implant and accrues over time based on patient risk factors. Patients with aortic stenosis undergoing TAVR also have a sizable risk of life-threatening or major bleeding. Although dual antiplatelet therapy for 3 to 6 months after TAVR is the guideline-recommended regimen, this practice is not well supported by current evidence. In patients with no indication for oral anticoagulation, current registry-based evidence suggests that single antiplatelet therapy may be safer than dual antiplatelet therapy. Similarly, oral anticoagulation monotherapy appears superior to anticoagulation plus antiplatelet therapy in those where oral anticoagulant use is indicated. To date, no risk prediction models have been established to guide antithrombotic therapy.CONCLUSIONS AND RELEVANCE Despite the growing volume of TAVR procedures to treat patients with severe aortic stenosis, evidence for adjunctive antithrombotic therapy remains rather scarce. Ongoing clinical trials will provide better understanding to guide antithrombotic therapy.

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Impact of HAS‐BLED score to predict trans femoral transcatheter aortic valve replacement outcomes

Abstract: HAS-BLED score could predict the risk of severe bleeding and mortality in patients who underwent TF-TAVR independent of the presence of atrial fibrillation.

Cited by 17 publications

References 23 publications

Cerebrovascular Events after Transcatheter Aortic Valve Replacement: The Difficulty in Predicting the Unpredictable

Cerebrovascular Events after Transcatheter Aortic Valve Replacement: The Difficulty in Predicting the Unpredictable

Modified percutaneous coronary intervention-derived risk models (PARIS and CREDO-Kyoto integer scoring systems) applied to Japanese transcatheter aortic valve replacement patients

Adjunctive Antithrombotic Therapy for Patients With Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

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