Impact of anemia on short-term outcomes after TAVR: Subgroup analysis from the BRAVO-3 randomized control trial
Presenter
Victor Yamada Razuk, MD, Icahn School of Medicine at Mount Sinai, New York, NY
Victor Yamada Razuk, MD1, Anton Camaj, MD1, Davide Cao, MD1, Johny Nicolas, MD2, Frans Beerkens, MD3, Samantha Sartori, PhD3, Roxana Mehran, M.D., MSCAI1, Christian Hengstenberg, MD4 and George D. Dangas, M.D., Ph.D., MSCAI5, (1)Icahn School of Medicine at Mount Sinai, New York, NY, (2)Icahn School of Medicine at Mount Sinai, New York City, New York, (3)Icahn School of Medicine at Mount Sinai, New York City, NY, (4)Medical University of Vienna, Vienna, Austria, (5)Mount Sinai Hospital, New York, NY
Keywords: TAVI/TAVR/Aortic Valve
Background:
Whether the periprocedural use of bivalirudin vs. unfractionated heparin (UFH) in anemic patients undergoing TAVR has a differential treatment effect on outcomes is unknown. We investigated the impact of bivalirudin vs. UFH on outcomes by anemia status in the BRAVO-3 trial.
Methods:
Patients were stratified according to the presence (Hb <13 g/dL in men and Hb <12 g/dL in females) or absence of anemia. The primary outcome was net adverse cardiac events (NACE), a composite of all-cause mortality, myocardial infarction, stroke, and major bleeding (BARC ≥3b) at 30 days.
Results:
Among 798 patients, 427 (53%) were anemic and 371 (46%) were not anemic of whom 221 (52%) and 179 (48%) received bivalirudin, respectively. No statistically significant difference in NACE was found between the two groups after adjustment for confounders and irrespective of the anticoagulant agent used (Table 1). However, anemic patients had higher rates of major vascular complications (adjusted OR 2.43 [95% CI: 1.42 - 4.16], p = 0.001) and acute kidney injury (adjusted OR 1.74 [95% CI: 1.16 - 2.59], p = 0.007) at 30 days.
Conclusions:
Anemia is not associated with higher rates of NACE at 30 days irrespective of the periprocedural anti-coagulant agent used. However, anemia 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 anemia should not be precluded from undergoing TAVR and bivalirudin is a safe and effective alternative for periprocedural anticoagulation during TAVR.
