title: Upper gastrointestinal bleeding following transcatheter aortic valve replacement: A retrospective analysis.
abstract: OBJECTIVE
  The aim of this study was to identify the incidence of upper gastrointestinal bleeding (UGIB) in the postprocedural period following transcatheter aortic valve replacement (TAVR).
  
  
  BACKGROUND
  As TAVR moves into intermediate- and low-risk patients, it has become increasingly important to understand its extracardiac complications. The patient population undergoing TAVR have clinical and demographic characteristics that place them at significant risk of UGIB. Practical aspects of TAVR, including use of antithrombotic therapy, further increase risk of UGIB.
  
  
  METHODS
  A retrospective single-center evaluation of 841 patients who underwent TAVR between January 2005 and August 2014 was performed in conjunction with analysis of referral patterns to the gastroenterology service for UGIB at the same site.
  
  
  RESULTS
  The overall risk of UGIB following TAVR was found to be 2.0% (n = 17/841). Additionally, the risk of UGIB in patients receiving triple antithrombotic therapy was found to be 10-fold greater than patients not receiving triple antithrombotic therapy (11.8% vs 1.0%). Endoscopy findings demonstrated five high-risk esophageal lesions including erosive esophageal ulcers, visible vessels at the GE junction, erosions at distal esophagus, and an actively bleeding esophageal ring that had been intubated through by the transesophageal echocardiography (TEE) probe.
  
  
  CONCLUSIONS
  This large cohort study demonstrates that TAVR is associated with a moderate risk of severe UGIB. The results of this study suggest that patients on triple antithrombotic therapy are at highest risk for severe UGIB. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Division of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Dylan E
authors.initials: DE
authors.lastname: Stanger
authors.affiliation: Division of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Alym H
authors.initials: AH
authors.lastname: Abdulla
authors.affiliation: Division of Gastroenterology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Frank T
authors.initials: FT
authors.lastname: Wong
authors.affiliation: Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Sina
authors.initials: S
authors.lastname: Alipour
authors.affiliation: Division of Gastroenterology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Bressler
authors.affiliation: Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: David A
authors.initials: DA
authors.lastname: Wood
authors.affiliation: Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: John G
authors.initials: JG
authors.lastname: Webb
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001955:British Columbia / Q000453:epidemiology; D004359:Drug Therapy, Combination; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: anticoagulants/antithrombins; antiplatelet therapy; aortic valve disease; bleeding; percutaneous intervention; percutaneous valve therapy; transcatheter valve implantation