Bleeding Following Alcohol Septal Ablation and Impact of Anticoagulant Choice: A Large Referral Center Experience

Background
Bleeding after coronary intervention is associated with poor outcomes and higher costs and the risk may vary according to anticoagulant (AC) choice. Alcohol septal ablation (ASA) is an effective therapy to treat heart failure due to obstructive hypertrophic cardiomyopathy (HCM). The frequency of bleeding and impact of AC choice is not adequately reported after ASA.

Methods
We conducted a retrospective review of all patients undergoing ASA between 2004-2015 at the Tufts HCM Center. Patients were stratified by the procedural AC, bivalirudin (BIV) or unfractionated heparin (UFH). Baseline characteristics, procedural bleeding, and transfusion were examined. We assigned preoperative risk according to standardized comorbidity indices. In-hospital bleeding events were classified according to GUSTO, TIMI, and BARC bleeding definitions.

Results
A total of 99 patients were included; 73 treated with BIV and 26 with UFH. Patients receiving BIV were older, had higher rates of oral AC use and had higher preoperative risk (p<0.01 for all, Table). Any in-hospital bleeding was observed in 9.1% of patients, while severe/major bleeding was observed in 3.0% of patients and overall transfusion rate was 2.0%. There were no differences in bleeding according to choice of procedural AC (Table).

Conclusions
This is the first report assessing antithrombotic strategies in ASA. In this large, consecutive series of ASA cases, we observed that the choice of procedural AC may be influenced by patient preoperative risk and when bleeding occurs, it is usually minor. Despite the baseline risk imbalance, the bleeding rates between BIV and UFH treated patients did not differ.