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Review of Bleeding and Thrombotic Risks Associated With Antithrombotic Therapy After Transcatheter Structural Heart Interventions.

ABSTRACT: Transcatheter structural heart interventions have drastically evolved over the past 2 decades. However, most catheterization procedures require the deployment of devices in the body; therefore, the adhesion of thrombi to those devices is a major problem, resulting in the requirement of a period of postprocedural antithrombotic regimen. However, in recent years, bleeding associated with these antithrombotic therapies has also become a major concern, attracting the attention of investigators. This is complicated by the fact that patients at high thrombotic risk are also at high bleeding risk, making the issue of administrating antithrombotic therapy challenging. The objective of this review was to identify the important issues and summarize the current status of postoperative antithrombotic therapy and assessment of the bleeding risk following transcatheter structural heart interventions such as transcatheter aortic valve replacement, transcatheter edge-to-edge repair, and transcatheter left atrial appendage occlusion.

SUBMITTER: Kawashima H

PROVIDER: S-EPMC10782401 | biostudies-literature | 2024 Jan

REPOSITORIES: biostudies-literature

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Review of Bleeding and Thrombotic Risks Associated With Antithrombotic Therapy After Transcatheter Structural Heart Interventions.

Kawashima Hideyuki H Numasawa Yohei Y Hayakawa Naoki N Asano Taku T Tanaka Shigemitsu S Torii Sho S Ueshima Daisuke D Hishikari Keiichi K Hioki Hirofumi H Watanabe Yusuke Y Mizutani Kazuki K Matsuo Yae Y Hayashida Kentaro K Jujo Kentaro K Nakazawa Gaku G

JACC. Asia 20231024 1

Transcatheter structural heart interventions have drastically evolved over the past 2 decades. However, most catheterization procedures require the deployment of devices in the body; therefore, the adhesion of thrombi to those devices is a major problem, resulting in the requirement of a period of postprocedural antithrombotic regimen. However, in recent years, bleeding associated with these antithrombotic therapies has also become a major concern, attracting the attention of investigators. This ...[more]

PMID: 38222261

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Project description:PurposeTo investigate the influence of antithrombotic therapy on occurrence of thrombotic and bleeding complications after endovascular aneurysm repair (EVAR).MethodsIn this retrospective single-center cohort study, patients who underwent elective endovascular aneurysm repair for abdominal aortic aneurysm were categorized into three antithrombotic groups: single antiplatelet therapy (SAPT), anticoagulants, or dual antiplatelet therapy (DAPT). Outcome measures were the incidence of major adverse cardiovascular events (MACE), prosthetic limb occlusions, and bleeding complications during follow-up.ResultsAmong 616 patients (SAPT: n = 450, anticoagulants: n = 84, and DAPT: n = 82), Kaplan-Meier analysis showed no significant difference (log-rank p = 0.37) in incidence of MACE between patients receiving SAPT (20.9%), anticoagulants (25.0%), and DAPT (14.6%) during a median follow-up of almost 4 years. In multivariable Cox regression analysis, only age (HR = 1.03; 95% CI 1.01-1.06, p = 0.01) and American Society of Anesthesiologists (ASA) classification (HR = 1.46; 95% CI 1.12-1.91; p = 0.01) were significant predictors for MACE. Prosthetic limb occlusion was observed in 38 patients during a median follow-up of 4 years; incidence between patients receiving SAPT (5.8%), anticoagulants (10.7%), and DAPT (3.7%) was not significantly different (log-rank p = 0.08). Age (HR = 0.96; 95% CI 0.92-1.00; p = 0.03) and use of anticoagulants (HR = 3.79, 95% CI 1.46-9.83; p < 0.01) were significant predictors for prosthetic limb occlusion. Bleeding complications occurred in 73 patients during median follow-up of almost 4 years, without significant difference (log rank p = 0.06) in incidence between patients receiving SAPT (10.7%), anticoagulants (19.0%), and DAPT (11.0%). ASA classification (HR = 1.74; 95% CI 1.23-2.46; p < 0.01) was a significant predictor for bleeding complications.ConclusionUse of anticoagulants after EVAR appears to be associated with a higher risk of prosthetic limb occlusion compared to the use of single or dual antiplatelet therapy.

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Review of Bleeding and Thrombotic Risks Associated With Antithrombotic Therapy After Transcatheter Structural Heart Interventions.

Publications

Review of Bleeding and Thrombotic Risks Associated With Antithrombotic Therapy After Transcatheter Structural Heart Interventions.

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