Title :

Primary hemostatic disorders and late major bleeding after transcatheter aortic valve replacement

Author(s) :

Kibler, Marion [Auteur]
Université de Strasbourg [UNISTRA]
Marchandot, Benjamin [Auteur]
Université de Strasbourg [UNISTRA]
Messas, Nathan [Auteur]
Université de Strasbourg [UNISTRA]
Labreuche, Julien [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Vincent, Flavien [Auteur]
Récepteurs nucléaires, maladies cardiovasculaires et diabète - U 1011 [RNMCD]
Grunebaum, Lelia [Auteur]
Centre Hospitalier Universitaire [Strasbourg] [CHU Strasbourg]
Hoang, Viet Anh [Auteur]
Université de Strasbourg [UNISTRA]
Reydel, Antje [Auteur]
Université de Strasbourg [UNISTRA]
Crimizade, Ulun [Auteur]
Université de Strasbourg [UNISTRA]
Kindo, Michel [Auteur]
Université de Strasbourg [UNISTRA]
Hoang, Minh Tam [Auteur]
Université de Strasbourg [UNISTRA]
Zeyons, Floriane [Auteur]
Université de Strasbourg [UNISTRA]
Trinh, Annie [Auteur]
Université de Strasbourg [UNISTRA]
Petit-Eisenmann, Helene [Auteur]
Université de Strasbourg [UNISTRA]
De Poli, Fabien [Auteur]
Centre hospitalier de Haguenau
Leddet, Pierre [Auteur]
Centre hospitalier de Haguenau
Duhamel, Alain [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Jesel, Laurence [Auteur]
Université de Strasbourg [UNISTRA]
Ohana, Mickael [Auteur]
Centre Hospitalier Universitaire [Strasbourg] [CHU Strasbourg]
Susen, Sophie [Auteur]
Récepteurs nucléaires, Maladies Cardiovasculaires et Diabète (EGID) - U1011
Ohlmann, Patrick [Auteur]
Université de Strasbourg [UNISTRA]
Van Belle, Eric [Auteur]
Récepteurs nucléaires, Maladies Cardiovasculaires et Diabète (EGID) - U1011
Morel, Olivier [Auteur]

Journal title :

Journal of the American College of Cardiology

Abbreviated title :

J. Am. Coll. Cardiol.

Volume number :

72

Pages :

2139-2148

Publication date :

2018-10-30

ISSN :

1558-3597

English keyword(s) :

transcatheter aortic valve replacement
von Willebrand syndrome
aortic stenosis
late major/life-threatening bleeding
paravalvular aortic regurgitation

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

Periprocedural and late (>30 days) bleedings represent major complications after transcatheter aortic valve replacement and have been identified as potential areas for improved patient care. The authors sought to evaluate ...
Show more >Periprocedural and late (>30 days) bleedings represent major complications after transcatheter aortic valve replacement and have been identified as potential areas for improved patient care. The authors sought to evaluate the impact of ongoing primary hemostasis disorders on late major/life-threatening bleeding complications (MLBCs). Bleedings were assessed according to the VARC-2 (Valve Academic Research Consortium-2) criteria. Closure time of adenosine diphosphate (CT-ADP), a surrogate marker of high molecular weight von Willebrand multimers proteolysis was assessed 24 h after the procedure. Ongoing primary hemostasis disorder was defined by a CT-ADP >180 s. Among 372 patients who survived at 30 days, MLBCs occurred in 42 patients (11.3%) at a median follow-up of 383 days (interquartile range: 188 to 574 days). MLBCs were mainly of gastrointestinal origin (42.8%) and were associated with increased overall mortality (hazard ratio [HR]: 5.66; 95% confidence interval [CI]: 3.10 to 10.31; p < 0.001) and cardiac mortality (HR: 11.62; 95% CI: 4.59 to 29.37; p < 0.001). A 2.5-fold elevation of MLBCs could be evidenced in patients with a CT-ADP > 180 s (27.4% vs. 11.5%; p < 0.001). Multivariate regression analysis identified paravalvular leak (PVL) (HR: 6.31; 95% CI: 3.43 to 11.60; p < 0.0001) and CT-ADP > 180 s (HR: 3.08; 95% CI: 1.62 to 5.81; p = 0.0005) as predictor of MLBCs. MLBCs after transcatheter aortic valve replacement are frequent and associated with an increased morbidity and mortality. PVL and CT-ADP >180 s were identified as strong predictors for MLBCs. These findings strongly suggest that persistent HMW defects contribute to enhanced bleeding risk in patients with residual PVL.Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

CHU Lille
Inserm
Institut Pasteur de Lille
Université de Lille

Collections :

• METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694
• Récepteurs nucléaires, Maladies Cardiovasculaires et Diabète (RNMCD) - U1011

Submission date :

2019-12-09T18:19:27Z
2024-05-23T14:13:06Z