Avvedimento, Marisa (2023) Late bleeding events in patients undergoing percutaneous coronary intervention in the workup pre-TAVR. [Tesi di dottorato]
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| Tipologia del documento: | Tesi di dottorato |
|---|---|
| Lingua: | English |
| Titolo: | Late bleeding events in patients undergoing percutaneous coronary intervention in the workup pre-TAVR |
| Autori: | Autore Email Avvedimento, Marisa m.avvedimento@gmail.com |
| Data: | 12 Dicembre 2023 |
| Numero di pagine: | 35 |
| Istituzione: | Università degli Studi di Napoli Federico II |
| Dipartimento: | Scienze Biomediche Avanzate |
| Dottorato: | Medicina clinica e sperimentale |
| Ciclo di dottorato: | 36 |
| Coordinatore del Corso di dottorato: | nome email Beguinot, Francesco beguino@unina.it |
| Tutor: | nome email Esposito, Giovanni [non definito] |
| Data: | 12 Dicembre 2023 |
| Numero di pagine: | 35 |
| Parole chiave: | Bleeding events, transcatheter aortic valve replacement |
| Settori scientifico-disciplinari del MIUR: | Area 06 - Scienze mediche > MED/11 - Malattie dell'apparato cardiovascolare |
| Depositato il: | 11 Gen 2024 10:16 |
| Ultima modifica: | 12 Ago 2026 05:36 |
| URI: | https://www.fedoa.unina.it/id/eprint/15636 |
Abstract
Objective. This study sought to determine the incidence, clinical characteristics, associated factors, and outcomes of late bleeding events (LBEs) in patients undergoing percutaneous coronary intervention (PCI) in the work-up pre-transcatheter aortic valve replacement (TAVR). Background. In patients undergoing PCI in the workup pre-TAVR, the incidence and clinical impact of LBEs remain largely unknown. Methods. This was a multicenter study including 1,457 consecutive patients (mean age, 81±7 years; 41.5% of women) who underwent TAVR and survived beyond 30 days. LBEs (>30 days post-TAVR) were defined according to the Valve Academic Research Consortium 2 (VARC-2) criteria. Results. LBEs occurred in 116 (7.9%) patients after a median follow-up of 23 (12 to 40) months. Late bleeding was minor, major, and life-threatening or disabling in 21 (18.1%), 63 (54.3%), and 32 (27.6%) patients, respectively. Periprocedural (<30 days post-TAVR) major bleeding and the combination of antiplatelet and anticoagulation therapy at discharge were independent factors associated with LBEs (p<0.02 for all). LBEs conveyed an increased mortality risk at 4-year follow-up compared with no bleeding (HR: 1.42,95%CI: 1.03 to 1.96, p=0.035). Also, LBE was identified as an independent predictor of all-cause mortality after TAVR (HR: 1.39; 95% CI: 1.05 to 1.83; p=0.020). Conclusions. In TAVR candidates with concomitant significant coronary artery disease (CAD) requiring percutaneous treatment, LBEs after TAVR were frequent and associated with increased mortality. Combining antiplatelet and anticoagulation regimens and the occurrence of periprocedural bleeding determined an increased risk of LBEs. Preventive strategies should be pursued for preventing late bleeding after TAVR, and further studies are needed to provide more solid evidence on the most safe and effective antithrombotic regimen post-TAVR in this challenging group of patients.
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