title: Risk factors for bleeding complications in patients undergoing transcatheter aortic valve implantation (TAVI).
abstract: BACKGROUND
  The risk of bleedings in transcatheter aortic valve implantation (TAVI) patients increases due to age and concomitant diseases. The aim of the study was to assess the risk of bleedings, their influence on early prognosis of TAVI patients and utility of the TIMI and GUSTO scales in the evaluation of bleeding and in prediction of blood transfusion.
  
  
  METHODS
  This was a single center study of in-hospital bleedings in 56 consecutive TAVI patients. Bleedings were classified according to the GUSTO and TIMI scales. HASBLED's scale risk factors, diabetes mellitus, female sex, the route of bioprosthesis implantation and inhospital antithrombotic treatment were analyzed. Statistical analysis consisted of c2, Fisher's exact, Wilcoxon tests and logistic regression analysis.
  
  
  RESULTS
  Serious bleedings occurred in 35 (62.5%) patients. There was no significant correlation with HASBLED score. History of anemia was a significant predictor of bleeding in GUSTO (p = 0.0013) and TIMI (p = 0.048) scales. No bleedings in patients receiving vitamin K antagonists (VKA) pre- and VKA plus clopidogrel post intervention were observed. Patients with bleedings according to the GUSTO scale more often required blood tranfusion than in TIMI scale (p = 0.03).
  
  
  CONCLUSIONS
  History of anemia is the strongest predictor of serious bleedings. VKA before and VKA with clopidogrel after TAVI are safer than dual antiplatelet or triple therapy. The TIMI and GUSTO scales can adequately classify bleeding after TAVI, however the GUSTO better predicts transfusions.
authors.affiliation: Intensive Cardiac Care Clinic, Institute of Cardiology, Warsaw, Poland. janina@stepinska.pl.pl.
authors.forename: Janina
authors.initials: J
authors.lastname: Stępińska
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Czerwińska
authors.forename: Adam
authors.initials: A
authors.lastname: Witkowski
authors.forename: Maciej
authors.initials: M
authors.lastname: Dąbrowski
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Chmielak
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Kuśmierski
authors.forename: Tomasz
authors.initials: T
authors.lastname: Hryniewiecki
authors.forename: Marcin
authors.initials: M
authors.lastname: Demkow
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications; D000925:Anticoagulants / Q000009:adverse effects; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000628:therapy*; D001803:Blood Transfusion; D006328:Cardiac Catheterization / Q000009:adverse effects*; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D004359:Drug Therapy, Combination; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D011044:Poland; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors