Bleeding-prone TAVI peri-procedural hemoglobin variation and platelet count as markers of access-site hemorrhage

Background

Access-site bleeding remains a frequent complication after transcatheter aortic valve implantation (TAVI), particularly in elderly heart failure populations with multiple comorbidities. Identifying simple hematological markers associated with bleeding risk may improve periprocedural management.

Aim

To evaluate the association between peri-procedural hemoglobin changes, baseline platelet count, and access-site hemorrhagic complications after TAVI.

Methods

We conducted a retrospective single-center analysis of consecutive patients undergoing TAVI. The primary endpoint was access-site hemorrhagic complication. Baseline demographic, clinical and hematological variables were collected. Hemoglobin drop was defined as pre-procedure minus post-procedure hemoglobin. Comparisons between patients with and without access-site bleeding were performed using appropriate parametric or non-parametric tests. Multivariable logistic regression was used to assess independent associations with bleeding, adjusting for age, sex, baseline platelet count, and baseline antithrombotic therapy.

Results

A total of 159 patients were included in the analysis; 33 patients (20.8%) experienced access-site hemorrhagic complications. The population was elderly (mean age 79.8 ± 7.4 years) and 60.4% were female. Hypertension (93.1%), diabetes mellitus (46.5%), chronic kidney disease (30.2%) and coronary artery disease (34.0%) were highly prevalent.

Patients with access-site bleeding had significantly lower baseline platelet counts compared with those without bleeding (183.8 ± 56.2 vs 209.6 ± 67.6 ×10⁹/L; p=0.028). Peri-procedural hemoglobin changes were numerically greater in bleeding patients (−2.6 ± 21.1 vs 0.8 ± 1.6 g/dL; p=0.354). Baseline oral anticoagulation was more frequent among bleeding patients (48.5% vs 33.3%; p=0.154), whereas baseline antiplatelet therapy was less frequent (27.3% vs 46.8%; p=0.049).

In multivariable analysis, higher baseline platelet count showed a protective trend against access-site bleeding (OR 0.73 per 50×10⁹/L; 95%CI 0.49–1.09), while peri-procedural hemoglobin drop showed no independent association after adjustment.

Conclusion

Access-site bleeding after TAVI occurs in approximately one-fifth of patients and is associated with lower baseline platelet counts. Baseline hematological profiling may help identify a bleeding-prone phenotype and support individualized bleeding avoidance strategies in heart failure-oriented TAVI pathways.Table 1.Baseline characteristics.For image description, please refer to the figure legend and surrounding text.