Abstract Number: OC 43.2
Meeting: ISTH 2022 Congress
Theme: Platelet Disorders, von Willebrand Disease and Thrombotic Microangiopathies » VWF and von Willebrand Factor Disorders - Clinical Conditions
Background: Aortic stenosis (AS) has been associated with an increased incidence of gastrointestinal (GI-) bleeding from angiodysplasia. The acquired Von Willebrand factor (VWF) high-molecular-weight (HMW) defect in AS-patients may account for this association. Whether trans-catheter aortic valve replacement (TAVR), allowing an immediate correction of the shear-induced VWF-defect, translates into a long-term reduction of blood transfusion is unknown.
Aims: To compare the long-term incidence of blood transfusion before and after TAVR-procedure.
Methods: We included 415 patients with severe-AS scheduled for TAVR in Lille University Hospital from 2010 to 2016 (WITAVI trial). All the transfusion events registered by the regional blood bank (Etablissement Français du Sang), in a period spanning the 5-years before and after TAVR-procedure, were first collected. After retrieving from medical records the events associated with bleeding, a Poisson regression model was used to compare blood transfusion incidence before and after TAVR-procedure, taking death as competing risk into account. VWF-HMW ratio and PFA-CADP were also measured before and at the end of TAVR-procedure.
Results: Mean age at inclusion was 81.9±7 and 200 patients died after TAVR (median follow-up = 3.4 years). Before TAVR, transfusion incidence progressively increased annually (from 0.03 in year-5 to 0.14 per-patient-year in year-1, p < 0.0001). At the time of TAVR, pre-procedural VWF HMW-ratio and PFA-CADP levels were significantly lower (both p < 0.0001) in patients with at least one pre-procedural transfusion. After TAVR allowing a within-day post-procedural correction of VWF-defect, a significant reduction in transfusion incidence was observed (RR = 0.53 [95%CI 0.38-0.72] compared to pre-procedural period), regardless of vital status at the end of follow-up (Table 1). After TAVR, the proportion of transfusion related to GI-bleeding also significantly decreased (p=0.006) and when the latter were explored endoscopically a ten-fold reduction in GI-angiodysplasia was observed (p < 0.0001).
Conclusion(s): TAVR is associated with a reduced incidence of blood transfusion and GI-bleeding from angiodysplasia.
To cite this abstract in AMA style:
Rauch A, Vincent F, Denimal T, Spillemaeker H, Pamart T, Jeanpierre E, Desvages M, Daniel M, Dupont A, Van Belle E, Susen S. Long-term reduction in blood transfusion incidence after correction of the shear-induced von Willebrand factor defect by TAVR-procedure [abstract]. https://abstracts.isth.org/abstract/long-term-reduction-in-blood-transfusion-incidence-after-correction-of-the-shear-induced-von-willebrand-factor-defect-by-tavr-procedure/. Accessed March 21, 2024.« Back to ISTH 2022 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/long-term-reduction-in-blood-transfusion-incidence-after-correction-of-the-shear-induced-von-willebrand-factor-defect-by-tavr-procedure/