Incidence, Current Guidelines and Management of Gastrointestinal Bleeding After Transcatheter Aortic Valve Replacement: A Systematic Review

Overview

Journal Curr Cardiol Rev

Publisher Bentham Science Publishers

Specialty Cardiology & Vascular Diseases

Date 2022 Jun 24

PMID 35747979

Authors

Devina Adalja

Harshvardhan Zala

Varun Victor

Aakash Sheth

Charles Willyard

Emi Suzuki

Harsh P Patel

Monil Majmundar

Saraschandra Vallabhajosyula

Rajkumar Doshi

Affiliations

Soon will be listed here.

Abstract

Background: There is a significant increase in morbidity and mortality in patients complicated by major bleeding following transcatheter aortic valve replacement (TAVR). It has become more challenging to manage such complications when the patient needs to be on anticoagulation or antiplatelet agent post-procedure to prevent thrombotic/embolic complications.

Methods: We systematically reviewed all available randomized controlled trials and observational studies to identify incidence rates of gastrointestinal bleeding post-procedure. After performing a systematic search, a total of 8731 patients from 15 studies (5 RCTs and 10 non-RCTs) were included in this review.

Results: The average rate of gastrointestinal bleeding during follow-up was 3.0% in randomized controlled trials and 1.9% among observational studies.

Conclusion: Gastrointestinal bleeding has been noted to be higher in the RCTs as compared to observational studies. This review expands knowledge of current guidelines and possible management of patients undergoing TAVR.

References

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009; 151(4):264-9, W64. DOI: 10.7326/0003-4819-151-4-200908180-00135. View

Stockl K, Le L, Zakharyan A, Harada A, Solow B, Addiego J . Risk of rehospitalization for patients using clopidogrel with a proton pump inhibitor. Arch Intern Med. 2010; 170(8):704-10. DOI: 10.1001/archinternmed.2010.34. View

Kibler M, Marchandot B, Messas N, Labreuche J, Vincent F, Grunebaum L . Primary Hemostatic Disorders and Late Major Bleeding After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol. 2018; 72(18):2139-2148. DOI: 10.1016/j.jacc.2018.08.2143. View

Otto C, Nishimura R, Bonow R, Carabello B, Erwin 3rd J, Gentile F . 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2020; 143(5):e35-e71. DOI: 10.1161/CIR.0000000000000932. View

Turgeon R, Barry A . Single vs Dual Antiplatelet Therapy Following Transcatheter Aortic Valve Implantation: A Systematic Review. Clin Cardiol. 2015; 38(10):629-34. PMC: 6490860. DOI: 10.1002/clc.22426. View

Van Mieghem N, Unverdorben M, Hengstenberg C, Mollmann H, Mehran R, Lopez-Otero D . Edoxaban versus Vitamin K Antagonist for Atrial Fibrillation after TAVR. N Engl J Med. 2021; 385(23):2150-2160. DOI: 10.1056/NEJMoa2111016. View

Stabile E, Pucciarelli A, Cota L, Sorropago G, Tesorio T, Salemme L . SAT-TAVI (single antiplatelet therapy for TAVI) study: a pilot randomized study comparing double to single antiplatelet therapy for transcatheter aortic valve implantation. Int J Cardiol. 2014; 174(3):624-7. DOI: 10.1016/j.ijcard.2014.04.170. View

Ma X, Xu Z, Li J, Zhao D, Kong X, Ma J . Antiplatelet strategy after transcatheter aortic valve replacement: an updated meta-analysis. J Cardiovasc Surg (Torino). 2019; 60(5):624-632. DOI: 10.23736/S0021-9509.19.10833-6. View

Gandhi S, Schwalm J, Velianou J, Natarajan M, Farkouh M . Comparison of Dual-antiplatelet Therapy to Mono-antiplatelet Therapy After Transcatheter Aortic Valve Implantation: Systematic Review and Meta-analysis. Can J Cardiol. 2015; 31(6):775-84. DOI: 10.1016/j.cjca.2015.01.014. View

10.

Ichibori Y, Mizote I, Maeda K, Onishi T, Ohtani T, Yamaguchi O . Clinical Outcomes and Bioprosthetic Valve Function After Transcatheter Aortic Valve Implantation Under Dual Antiplatelet Therapy vs. Aspirin Alone. Circ J. 2017; 81(3):397-404. DOI: 10.1253/circj.CJ-16-0903. View

11.

Hioki H, Watanabe Y, Kozuma K, Nara Y, Kawashima H, Kataoka A . Pre-procedural dual antiplatelet therapy in patients undergoing transcatheter aortic valve implantation increases risk of bleeding. Heart. 2016; 103(5):361-367. DOI: 10.1136/heartjnl-2016-309735. View

12.

Veitch A, Baglin T, Gershlick A, Harnden S, Tighe R, Cairns S . Guidelines for the management of anticoagulant and antiplatelet therapy in patients undergoing endoscopic procedures. Gut. 2008; 57(9):1322-9. DOI: 10.1136/gut.2007.142497. View

13.

Ussia G, Scarabelli M, Mule M, Barbanti M, Sarkar K, Cammalleri V . Dual antiplatelet therapy versus aspirin alone in patients undergoing transcatheter aortic valve implantation. Am J Cardiol. 2011; 108(12):1772-6. DOI: 10.1016/j.amjcard.2011.07.049. View

14.

Lynch Jr D, Dantzler D, Robbins M, Zhao D . Considerations in antithrombotic therapy among patients undergoing transcatheter aortic valve implantation. J Thromb Thrombolysis. 2013; 35(4):476-82. DOI: 10.1007/s11239-013-0886-z. View

15.

Wysocki J, Srivastav S, Winstead N . A nationwide analysis of risk factors for mortality and time to endoscopy in upper gastrointestinal haemorrhage. Aliment Pharmacol Ther. 2012; 36(1):30-6. DOI: 10.1111/j.1365-2036.2012.05129.x. View

16.

Tarantini G, Gasparetto V, Napodano M, Frigo A, Fraccaro C, Buja P . Transcatheter aortic valve implantation and bleeding: focus on Valve Academic Research Consortium-2 classification. Int J Cardiol. 2013; 168(5):5001-3. DOI: 10.1016/j.ijcard.2013.07.123. View

17.

Naoum C, Blanke P, Dvir D, Pibarot P, Humphries K, Webb J . Clinical Outcomes and Imaging Findings in Women Undergoing TAVR. JACC Cardiovasc Imaging. 2016; 9(4):483-93. DOI: 10.1016/j.jcmg.2016.02.009. View

18.

Grove E, Wurtz M, Schwarz P, Jorgensen N, Vestergaard P . Gastrointestinal events with clopidogrel: a nationwide population-based cohort study. J Gen Intern Med. 2012; 28(2):216-22. PMC: 3614150. DOI: 10.1007/s11606-012-2208-0. View

19.

Berg J, Sibbing D, Rocca B, Van Belle E, Chevalier B, Collet J . Management of antithrombotic therapy in patients undergoing transcatheter aortic valve implantation: a consensus document of the ESC Working Group on Thrombosis and the European Association of Percutaneous Cardiovascular Interventions (EAPCI), in.... Eur Heart J. 2021; 42(23):2265-2269. DOI: 10.1093/eurheartj/ehab196. View

20.

Garg S, Anugwom C, Campbell J, Wadhwa V, Gupta N, Lopez R . Early esophagogastroduodenoscopy is associated with better Outcomes in upper gastrointestinal bleeding: a nationwide study. Endosc Int Open. 2017; 5(5):E376-E386. PMC: 5432117. DOI: 10.1055/s-0042-121665. View