Public Health and Epidemiology: Open Access
Outcomes of Transcatheter Aortic Valve Replacement in Patients with Underlying Hypercoagulable States
Abstract
Kartikeya Srivastava, Nishat Shama, Anza Muhammad, Thirumurugan Sivakumaar, Mrinal Bhandari, Likhith Sai Mandava, Rakshaya Venu, Paras Singh Chandi, Aryan Srivastava, Malaika Shahid Qureshi, Affaf Shahid, Ghulam Mujtaba Khalid and Laiba Khalid
Background: Thrombotic complications remain an important concern after transcatheter aortic valve replacement (TAVR), particularly because leaflet thrombosis may impair prosthetic valve function and contribute to adverse clinical outcomes. Patients with pre-existing hypercoagulable disorders may represent a higher-risk subgroup, yet their outcomes after TAVR have not been well characterized. We evaluated whether selected hypercoagulable conditions were associated with worse inpatient outcomes following TAVR.
Methods: The National Inpatient Sample was queried from 2018 through 2020 to identify adult hospitalizations involving TAVR. Hypercoagulable status was defined by the presence of systemic lupus erythematosus, antiphospholipid antibody syndrome, Factor V Leiden mutation, lupus anticoagulant syndrome, or prothrombin gene mutation using ICD-10-CM codes. Among 205,565 TAVR hospitalizations, 1,480 involved patients with one or more of these conditions. Baseline characteristics were compared using Mann-Whitney U and Chi-square testing. Multivariable logistic regression was then used to assess the relationship between hypercoagulable status and inpatient clinical outcomes, with statistical significance defined as p < 0.05.
Results: The study cohort had a median age of 80 years (IQR 73–85), and 43.9% were female. After adjustment, the presence of a hypercoagulable condition was not independently associated with a statistically significant increase in any primary or secondary inpatient outcome. However, several clinically relevant trends were observed. Patients with hypercoagulable states had numerically higher odds of all-cause mortality (OR 1.68) and major adverse cardiovascular events (OR 1.36). They also demonstrated higher odds of prosthetic valve leakage (aOR 1.14) and prosthetic valve thrombosis (aOR 5.03), although these associations did not reach statistical significance. Conversely, post-procedural pacemaker implantation (OR 0.86) and cerebrovascular accident (OR 0.72) were numerically less frequent in the hypercoagulable group.
Conclusion: In a national cohort of patients undergoing TAVR, underlying hypercoagulable disorders were not significantly associated with worse adjusted inpatient outcomes. Nevertheless, the direction of effect for mortality, MACE, prosthetic valve leakage, and particularly prosthetic valve thrombosis suggests a possible signal toward increased thrombotic and adverse cardiovascular risk. These findings highlight the need for larger studies with more granular clinical and antithrombotic data to better define post-TAVR risk and management strategies in patients with hypercoagulable conditions.