Background & Aims
Gastrointestinal bleeding (GIB) is the most common bleeding complication post transcatheter aortic valve replacement (TAVR). Yet, the literature is sparse and incomplete. This study aims to identify the incidence and risk factors for GIB immediately following TAVR.
A retrospective study was performed among 489 patients who were hospitalized for TAVR at UC Davis Medical Center from (January 1, 2012 to June 30, 2017). The incidence of both upper and lower GIB, and potential risk factors during the same hospitalization were reviewed. Univariate analysis was done to identify independent risk factors.
Mean age was 81.6 years and 49% were male, 23% had CKD3 or worse, 34% had history of prior GIB. Mean baseline Hgb and platelet count were 12.0 g/dl and 197000/ml, respectively. Dual antiplatelet therapy and anticoagulation were used in 396 (81%) and 155 (32%) patients, respectively. Gastric prophylaxis with either PPIs or H2 receptor blockers was used in 336 (69%). Incidence of GIB was 1.4% (7/489) with 5 cases of upper GIB, 1 small intestinal GIB and 1 lower GIB. The most common culprit lesion found during endoscopy was angiodysplasia (3/5) and successful endoscopic intervention was performed. On univariate regression analysis, only a low hemoglobin level on admission was associated with increased likelihood of GIB (OR=1.49, p=0.051 per 1 g/dl decrease).
GIB is rare immediately post-TAVR. Angiodysplasia was the most common etiology in our series. Baseline anemia is a predictor of GIB in this setting.