Anaemia Has No Impact on Short-Term Outcomes Following Transcatheter Aortic Valve Replacement

April 30, 2021
By Eric Ramos VIRTUAL -- April 29, 2021 -- Patients with anaemia who undergo transcatheter aortic valve replacement (TAVR) and receive periprocedural bivalirudin or unfractionated heparin do not appear to have higher rates of adverse cardiac events 30 days after the procedure, according to a study presented at the 2021 Virtual Scientific Sessions of the Society for Cardiovascular Angiography and Interventions (SCAI). However, patients who were anaemic had higher rates of major vascular complications and acute kidney injury, reported Victor Yamada Razuk, MD, Icahn School of Medicine at Mount Sinai, New York, New York. The findings come from an analysis of the BRAVO-3 study, which assessed the safety and efficacy of using bivalirudin instead of unfractionated heparin in patients undergoing TAVR. Of the 798 patients in the study, 427 (53%) had anaemia. Among the patients with anaemia, 221 (52%) were randomised to receive bivalirudin, and among patients without anaemia, 179 (48%) were randomised to bivalirudin. Among the patients with anaemia, 68 (15.9%) experienced the composite endpoint of all-cause mortality, myocardial infarction, stroke, and major bleeding at 30 days (net adverse cardiac events), as did 51 (13.7%) of the patients without anaemia (odds ratio [OR] = 1.19; 95% confidence interval [CI], 0.80-1.76; P = .389). After adjusting for age, sex, glomerular filtration rate, prior cerebrovascular/transient ischaemic attack, coronary artery disease, prior atrial fibrillation, there was still no statistically significant differences in net adverse cardiac events between groups (adjusted OR = 1.13; 95% CI, 0.75-1.69; P = .561). However, at 30 days, patients with anaemia had higher rates of major vascular complications (12.6% vs 5.7%; adjusted OR = 2.43; 95% CI, 1.42-4.16; P = .001) and acute kidney injury (20.4% vs 12.1%; adjusted OR = 1.74; 95% CI, 1.16-2.59; P = .007). There were no differences in life threatening bleeding events or major bleeding events at 30 days. “Anaemia was not associated with higher rates of net adverse cardiac events at 30 days, irrespective of the periprocedural anti-coagulant agent used,” said Dr. Razuk. “However, anaemia was associated with higher rates of major vascular complications and acute kidney injury at 30 days. High-risk surgical patients with severe symptomatic aortic stenosis and anaemia should not be precluded from undergoing TAVR, and bivalirudin is a safe and effective alternative for periprocedural anticoagulation during TAVR.” [Presentation title: Impact of Anemia on Short-Term Outcomes After TAVR: Subgroup Analysis From the BRAVO-3 Randomized Control Trial. Poster J-16]