Vol 20, No 2 (2013)
Original articles
Published online: 2013-04-05

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Risk factors for bleeding complications in patients undergoing transcatheter aortic valve implantation (TAVI)

Janina Stępińska, Katarzyna Czerwińska, Adam Witkowski, Maciej Dąbrowski, Zbigniew Chmielak, Krzysztof Kuśmierski, Tomasz Hryniewiecki, Marcin Demkow
DOI: 10.5603/CJ.2013.0024
Cardiol J 2013;20(2):125-133.


Background: The risk of bleedings in transcatheter aortic valve implantation (TAVI) patients
increases due to age and concomitant diseases. The aim of the study was to assess the risk of
bleedings, their influence on early prognosis of TAVI patients and utility of the TIMI and
GUSTO scales in the evaluation of bleeding and in prediction of blood transfusion.

Methods: This was a single center study of in-hospital bleedings in 56 consecutive TAVI
patients. Bleedings were classified according to the GUSTO and TIMI scales. HASBLED‘s
scale risk factors, diabetes mellitus, female sex, the route of bioprosthesis implantation and inhospital
antithrombotic treatment were analyzed. Statistical analysis consisted of c2, Fisher’s
exact, Wilcoxon tests and logistic regression analysis.

Results: Serious bleedings occurred in 35 (62.5%) patients. There was no significant
correlation with HASBLED score. History of anemia was a significant predictor of bleeding in
GUSTO (p = 0.0013) and TIMI (p = 0.048) scales. No bleedings in patients receiving
vitamin K antagonists (VKA) pre- and VKA plus clopidogrel post intervention were observed.
Patients with bleedings according to the GUSTO scale more often required blood tranfusion
than in TIMI scale (p = 0.03).

Conclusions: History of anemia is the strongest predictor of serious bleedings. VKA before
and VKA with clopidogrel after TAVI are safer than dual antiplatelet or triple therapy. The
TIMI and GUSTO scales can adequately classify bleeding after TAVI, however the GUSTO
better predicts transfusions.