Patients with atrial fibrillation (AF) are likely to have multiple co-morbidities which lead to a poor prognosis including bleeding events. Closure time adenosine diphosphate (CT-ADP) is a primary hemostasis point-of-care test used as a surrogate marker of high molecular weight multimers defect of Von Willebrand factor. Our prior studies suggest that prolongation of CT-ADP (>180sec) after TAVR is a determinant of major/life-threatening bleeding complications (MLBCs).

To evaluate the impact of post-procedural CT-ADP>180sec on bleeding events in TAVR patients with AF.

We included 878 patients from our prospective TAVR registry. Bleeding complications were assessed according to the VARC-2 criteria. Major adverse cardiac and cerebrovascular events (MACCE) was defined as a composite of all-cause death, myocardial infarction, stroke, and heart failure hospitalization after TAVR. Primary endpoint was 1-year MLBCs and the second endpoint was 1-year MACCE.

Patients with AF had a higher incidence of all-cause mortality (15% vs. 8%, P=0.002), MACCE (29% vs. 20%, P=0.002), and MLBCs (20% vs. 12%, P=0.001) within 1-year compared to non-AF patients. When the cohort was split into 4 subgroups according to AF and CT-ADP>180sec, patients with AF and CT-ADP>180sec had the highest risk of MLBCs (log-rank test; P<0.001) (Figure 1). Multivariate Cox regression analysis confirmed that the patients with AF and CT-ADP>180sec had 4.6-fold higher risk of MLBCs within 1 year compared to non-AF patients with CT-ADP≤180sec (hazard ratio: 4.60; 95% confidence interval: 2.18-9.68; P<0.001) (Figure 1).

Among TAVR patients, AF with post-procedural CT-ADP>180sec was identified as a strong predictor of MLBCs at 1-year follow-up. Our study suggest that persistent primary haemostasis disorders contribute to a higher risk of bleeding events particularly in AF patients and may be considered for a tailored and risk-adjusted antithrombotic therapy after TAVR.