Valvular & structural heart disease
Refining Bleeding Risk Stratification After Transcatheter Aortic Valve Replacement (TAVR): Added Value of Closure Time of Adenosine Diphosphate (CT-ADP) Beyond High Bleeding Risk Criteria
Authors' conclusion
Postprocedural CT-ADP assessment enhances bleeding risk stratification beyond VARC-HBR criteria and may support individualized management strategies in high-risk TAVR patients.
Study context
- Population
- TAVR patients from a prospective registry, bleeding risk by Valve Academic Research Consortium for High Bleeding Risk (VARC-HBR) criteriaanalysed
- Participants
- 884 patients
- Exposure
- Postprocedural CT-ADP >180 seconds vs ≤180 seconds, added to VARC-HBR criteria
- VARC-HBRn = 614
- CT-ADP >180 secondsn = 220
- Outcome
- Major bleeding
- Follow-up
- 2 years
Main finding
As reported in the abstract
2-year major bleeding
VARC-HBR vs Non-HBR: P < 0.0001 · CT-ADP >180 seconds vs CT-ADP ≤180 seconds: P < 0.0001
- Predictive accuracy for 2-year bleeding, VARC-HBR score plus postprocedural CT-ADP >180 seconds (from 0.65 to 0.69)
- P = 0.00012
Observational data: associations, not effects.
Further findings
| Outcome | P value |
|---|---|
| Late bleeding, landmark analysis, among VARC-HBRCT-ADP >180 seconds vs CT-ADP ≤180 seconds · 11.4% vs 2.4%; log-rank | P < 0.0001 |
CT-ADP, pre-TAVR vs 24 hours postprocedure
- CT-ADP decreased: 170 seconds [124-300 seconds] vs 125 seconds [97-180 seconds]
- P < 0.0001
Late bleeding, landmark analysis, among VARC-HBR
- VARC-HBR criteria predicted periprocedural bleeding but not late bleeding
Original publication
Refining Bleeding Risk Stratification After TAVR: Added Value of CT-ADP Beyond High Bleeding Risk Criteria. JACC Cardiovasc Interv. Published 27 August 2025. doi:10.
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