Valve Thrombosis After TAVR: Larger-Diameter Valves and No Warfarin as Predictors

There are limited data on the incidence, clinical implications, and predisposing factors of valve thrombosis in patients who underwent transcatheter aortic valve replacement (TAVR). This study aimed at determining such information through multislice computed tomography (CT).

This trial included 460 consecutive patients who underwent TAVR with a balloon-expandable Edwards Sapien XT or Sapien 3 (Edwards Lifesciences, Irvine, California) device.

Of those, 405 patients were assessed through multislice CT in addition to transthoracic or transesophageal echocardiography 1 to 3 months after TAVR. CT scans were evaluated for hypodense thickening matching valve thrombosis.

The CT confirmed signs of valve thrombosis in 28 patients (7%), 23 of which were completely asymptomatic. The remaining 5 patients presented symptoms indicating obstructive valve thrombosis.

Valve thrombosis risk did not differ among different generations of devices, but it was more frequent in patients who did not receive warfarin when compared with anticoagulated patients (10.7% vs. 1.8%; risk ratio [RR]: 6.09; 95% confidence interval [CI]: 1.86 to 19.84). Larger-diameter valves were associated with an increased risk of thrombosis (p = 0.03).

In a multivariable analysis, 29-mm devices (RR: 2.89; 95% CI: 1.44 to 5.80) and no post-TAVR warfarin treatment (RR: 5.46; 95% CI: 1.68 to 17.7) were independent predictors of thrombosis.

Treatment with warfarin effectively reverted valve thrombosis in 85% of patients, as shown by follow-up transesophageal echocardiography and multislice computed tomography.

Conclusion

Incidence of valve thrombosis after transcatheter aortic valve replacement in this study was 7%. Larger-diameter valves showed higher predisposition to thrombosis, whereas warfarin treatment had a protective effect. Although most patients did not present symptoms, the clinical implications of valve thrombosis may be important.

Original title: Transcatheter Aortic Valve Thrombosis Incidence, Predisposing Factors, and Clinical Implications.

Reference: Nicolaj C. Hansson et al. J Am Coll Cardiol. 2016;68(19):2059-2069.

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