Types of Bleeding Following Mechanical Aortic Valve Replacement

OBJECTIVES: Mechanical aortic valve prostheses have long durability but require lifelong anticoagulation, which increases the risk of bleeding. However, the types of bleeding complications following mechanical aortic valve replacement (AVR) are not well known. Therefore, we conducted this study to investigate various types of bleeding following mechanical AVR. METHODS: In this nationwide, observational cohort study, all patients who underwent mechanical AVR in Sweden between 1997 and 2022 were included. Patients were identified using the SWEDEHEART registry. The primary outcome was the types of first major bleeding event that required hospitalization following mechanical AVR. These outcomes were obtained from the Swedish National Patient Register based on International Classification of Diseases (ICD) codes. RESULTS: In total, 13 508 patients underwent mechanical AVR. Of these, 2029 patients (15%) had a major bleeding event. The mean age was 58 years (95% CI, 57.9-58.3), and 29% were females. Bleeding complications included gastrointestinal bleeding (40%), intracranial bleeding (24%), hematuria (15%), epistaxis (13%), bleeding-induced anaemia (5.4%), airway bleeding (1.6%), and hemopericardium/haemothorax (1.3%). At 20 years, the cumulative incidences of gastrointestinal and intracranial bleeding were 9.0% (95% CI, 8.4-9.6) and 5.3% (95% CI, 4.8-5.8). CONCLUSIONS: Gastrointestinal and intracranial bleeding account for the majority of bleeding complications following mechanical AVR, followed by hematuria and epistaxis. Future studies on strategies to reduce bleeding complications in this population are needed.