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

Background: 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.

Methods: In a prospective TAVR registry, patients were stratified according to upper GI bleeding within 1 year of discharge.

Results: 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.

Conclusions: 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.

Trial registration number: NCT01368250.