Incidence, predictors and clinical impact of upper gastrointestinal bleeding after transcatheter aortic valve replacement.

Abstract

Upper gastrointestinal (GI) bleeding following transcatheter aortic valve replacement (TAVR) is common in patients with aortic stenosis due to the combination of acquired type 2A von Willebrand disease and aspirin-based antiplatelet therapy. We aimed to investigate the incidence, predictors and clinical outcomes of late upper GI bleeding in patients undergoing TAVR. In a prospective TAVR registry, patients were stratified according to upper GI bleeding within 1 year of discharge. Among the 3144 eligible patients, 54 (1.7%) experienced upper GI bleeding after discharge. Of these, 40 patients had major or life-threatening bleeding, while 14 had minor bleeding events. The presence of atrial fibrillation or atrial flutter (HR_adjusted 2.98; 95% CI 1.65 to 5.38) and previous upper GI bleeding (HR_adjusted 3.51; 95% CI 1.51 to 8.19) were independent predictors of upper GI bleeding, while the use of proton pump inhibitors at discharge (HR_adjusted 0.49; 95% CI 0.27 to 0.89) and higher haemoglobin levels (1 g/dL increase) (HR_adjusted 0.73; 95% CI 0.62 to 0.87) were protective. Patients who experienced major or life-threatening upper GI bleeding had a higher all-cause (73.7% vs 11.4%, HR 5.84; 95% CI 3.41 to 10.02) and cardiovascular mortality (31.6% vs 7.3%, HR 3.87; 95% CI 1.72 to 8.70) compared with those without upper GI bleeding. Among patients who underwent TAVR, 1.7% of patients experienced upper GI bleeding within 1 year of discharge. Major or life-threatening upper GI bleeding was associated with an increased risk of all-cause and cardiovascular mortality. NCT01368250.