Hematological Complications From Transcatheter Aortic Valve Replacement (TAVR): Recognition and Treatment

Author:

Bhargava Sahil1,Maheta Darshilkumar2,Agrawal Siddharth Pravin3,Raval Maharshi3,Frishman William H.4,Aronow Wilbert S.5

Affiliation:

1. Department of Medicine, Smt. NHLMMC, Ahmedabad, India

2. Department of Public Health, New York Medical College, Valhalla, NY

3. Department of Internal Medicine, New York Medical College/Landmark Medical Center, Woonsocket, RI

4. Department of Medicine, New York Medical College, Valhalla, NY

5. Department of Cardiology and Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY.

Abstract

Transcatheter aortic valve replacement (TAVR) has emerged as a pivotal intervention for patients with severe aortic stenosis who are at high or prohibitive surgical risk. Although TAVR is a minimally invasive procedure, it is linked to serious hematological problems, most notably thrombosis and bleeding. Numerous factors, such as procedural features, patient comorbidities, and anticoagulation management techniques, contribute to these complications. Bleeding complications can be major, minor, or life-threatening. They can be caused by problems with the vascular access site, anticoagulation medication, or coexisting conditions like renal dysfunction and frailty. Hemoglobin drop, overt bleeding, and hematoma signs must all be closely watched to identify bleeding. Careful selection and modification of anticoagulation medication, the use of vascular closure devices, and timely attention to bleeding sites are examples of management techniques. Thrombotic consequences, which include cerebrovascular accidents and valve thrombosis, are caused by endothelial injury, stent implantation, and patient hypercoagulability. Imaging modalities such as computed tomography and transesophageal echocardiography are used in the crucial process of detection. The goal of preventive care is to maximize anticoagulation regimens that are customized to each patient’s risk profile, frequently striking a balance between the risk of thrombosis and bleeding. A multidisciplinary strategy that integrates surgical, hematological, and cardiology expertise is necessary for the effective management of these hematological complications. To improve patient outcomes, ongoing research attempts to improve risk stratification and create safer anticoagulation protocols. This review emphasizes how critical it is to identify bleeding and thrombotic events as soon as possible and treat them promptly to reduce the risk of negative outcomes for TAVR patients.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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