• PE, but Not DVT, After TAVR Associated With Higher In-Hospital Mortality Risk

    Pulmonary embolism (PE) was associated with an increased risk of in-hospital mortality when it happens after transcatheter aortic valve replacement (TAVR), but the same is not true of deep vein thrombosis (DVT), according to an analysis presented Friday at CRT 2021 Virtual.

    TAVR procedures have skyrocketed in the past decade. Most TAVR patients have risk factors for thromboembolic events, which may occur arterially or venously. However, arterial thrombosis is relatively better studied, said Saurav Chatterjee, MD, of Long Island Jewish Hospital/Northwell Health, New York, who presented the abstract.

    He pointed out that while venous thromboembolism (VTE, which includes DVT and PE) is considered a patient safety indicator and a quality metric of in-hospital care, none of the major TAVR trials reported venous thromboembolic events. In addition, there are no reports from prospective TAVR registries.

    Chatterjee presented an analysis of 7,802 patients treated with TAVR from 2011 through 2014 whose data were available in the National Inpatient Sample. The analysis used International Classification of Diseases Clinical Modification, 9th Revision (ICD-9) procedure codes for TAVR and Centers for Medicare and Medicaid Services Patient Safety Indicator ICD-9 codes for venous thromboembolic events.

    The patients’ mean age was 81.19±8.5 years, 47.6% were women, and their median hospital length of stay was 6 days.

    The in-hospital VTE incidence was 0.9% (95% confidence interval [CI]: 0.8% to 1.2%; acute in-hospital DVT was 0.82% (95% CI: 0.64% to 1.04%); and incidence of in-hospital PE was 0.27% (95% CI: 0.18% to 0.41%).

    PE was associated with a significantly increased odds of in-hospital all-cause mortality in TAVR patients (odds ratio [OR]: 5.69; 95% CI: 1.9-17.0; p=0.002). However, DVT was not associated with in-hospital all-cause mortality (OR: 2.04; 95% CI: 0.81-5.13; p=0.13). There was no decrease in the trend for incidence of VTE in the years assessed (p=0.86 for trend).

    Chatterjee said this was one of the first investigations of venous thromboembolic risk with TAVR. It was similar to the risk of VTE after cardiac surgery, including valve surgery, and it was consistent with a prior signal of mortality risk with VTE after coronary artery bypass grafting, he said.

    Study limitations include those associated with an analysis of national databases, ICD-9 codes, the cross-sectional design, that only in-hospital events were measured, and that more recent years were not evaluated.

    Chatterjee said the results show that it is important to identify a mechanistic basis for VTE in TAVR and to identify the true scope of the problem using independent datasets. Finally, he said the results show that there is a need to identify optimal strategies to mitigate the risk of VTE in TAVR, including choosing an effective thromboprophylaxis option.

    CRT 2021 Virtual takes place Fridays and Saturdays through April 24. On-demand content from the meeting is available here.   

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