Universität zu Köln

Al-Kassou, Baravan, Veulemans, Verena, Shamekhi, Jasmin, Maier, Oliver, Piayda, Kerstin, Zeus, Tobias, Aksoy, Adem, Zietzer, Andreas, Meertens, Max, Mauri, Victor, Weber, Marcel, Sinning, Jan-Malte, Grube, Eberhard, Adam, Matti, Bakhtiary, Farhad, Zimmer, Sebastian, Baldus, Stephan, Kelm, Malte, Nickenig, Georg and Sedaghat, Alexander (2023). Optimal protamine-to-heparin dosing ratio for the prevention of bleeding complications in patients undergoing TAVR-A multicenter experience. Clin. Cardiol., 46 (1). S. 67 - 76. HOBOKEN: WILEY. ISSN 1932-8737

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Abstract

Background Despite major advances, transcatheter aortic valve replacement (TAVR) is still associated with procedure-specific complications. Although previous studies reported lower bleeding rates in patients receiving protamine for heparin reversal, the optimal protamine-to-heparin dosing ratio is unknown. Hypothesis The aim of this study was a comparison of two different heparin antagonization regimens for the prevention of bleeding complications after TAVR. Methods The study included 1446 patients undergoing TAVR, of whom 623 received partial and 823 full heparin antagonization. The primary endpoint was a composite of 30-day mortality, life-threatening, and major bleeding. Safety endpoints included stroke and myocardial infarction at 30 days. Results Full antagonization of heparin resulted in lower rates of the primary endpoint as compared to partial heparin reversal (5.6% vs. 10.4%, p < .01), which was mainly driven by lower rates of life-threatening (0.5% vs. 1.6%, p = .05) and major bleeding (3.2% vs. 7.5%, p < .01). Moreover, the incidence of major vascular complications was significantly lower in patients with full heparin reversal (3.5% vs. 7.5%, p < .01). The need for red-blood-cell transfusion was lower in patients receiving full as compared to partial heparin antagonization (10.4% vs. 15.9%, p < .01). No differences were observed in the incidence of stroke and myocardial infarction between patients with full and partial heparin reversal (2.2% vs. 2.6%, p = .73 and 0.2% vs. 0.4%, p = .64, respectively). Conclusions Full heparin antagonization resulted in significantly lower rates of life-threatening and major bleeding after TAVR as compared to partial heparin reversal. The occurrence of stroke and myocardial infarction was low and comparable between both groups.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Al-Kassou, Baravan UNSPECIFIED UNSPECIFIED UNSPECIFIED Veulemans, Verena UNSPECIFIED UNSPECIFIED UNSPECIFIED Shamekhi, Jasmin UNSPECIFIED UNSPECIFIED UNSPECIFIED Maier, Oliver UNSPECIFIED UNSPECIFIED UNSPECIFIED Piayda, Kerstin UNSPECIFIED UNSPECIFIED UNSPECIFIED Zeus, Tobias UNSPECIFIED UNSPECIFIED UNSPECIFIED Aksoy, Adem UNSPECIFIED UNSPECIFIED UNSPECIFIED Zietzer, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Meertens, Max UNSPECIFIED UNSPECIFIED UNSPECIFIED Mauri, Victor UNSPECIFIED UNSPECIFIED UNSPECIFIED Weber, Marcel UNSPECIFIED UNSPECIFIED UNSPECIFIED Sinning, Jan-Malte UNSPECIFIED UNSPECIFIED UNSPECIFIED Grube, Eberhard UNSPECIFIED UNSPECIFIED UNSPECIFIED Adam, Matti UNSPECIFIED UNSPECIFIED UNSPECIFIED Bakhtiary, Farhad UNSPECIFIED UNSPECIFIED UNSPECIFIED Zimmer, Sebastian UNSPECIFIED UNSPECIFIED UNSPECIFIED Baldus, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Kelm, Malte UNSPECIFIED UNSPECIFIED UNSPECIFIED Nickenig, Georg UNSPECIFIED UNSPECIFIED UNSPECIFIED Sedaghat, Alexander UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-671683
DOI:	10.1002/clc.23936
Journal or Publication Title:	Clin. Cardiol.
Volume:	46
Number:	1
Page Range:	S. 67 - 76
Date:	2023
Publisher:	WILEY
Place of Publication:	HOBOKEN
ISSN:	1932-8737
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language AORTIC-VALVE-REPLACEMENT; CONSENSUS DOCUMENT; BLOOD-LOSS; TRANSCATHETER; IMPLANTATION; MANAGEMENT; ASSOCIATION; EFFICACY; STENOSIS; SAFETY Multiple languages Cardiac & Cardiovascular Systems Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/67168