A1 Refereed original research article in a scientific journal
Major bleeding complications and antithrombotic treatment after isolated surgical bioprosthetic aortic valve replacement
Authors: Björn, Rikhard; Lehto, Joonas; Malmberg, Markus; Anttila, Vesa; Gunn, Jarmo; Nieminen, Tuomo; Hartikainen, Juha; Biancari, Fausto; Airaksinen, K.E. Juhani; Kiviniemi, Tuomas
Publication year: 2026
Journal: International journal of cardiology : heart & vasculature
Article number: 101861
Volume: 62
eISSN: 2352-9067
DOI: https://doi.org/10.1016/j.ijcha.2025.101861
Publication's open availability at the time of reporting: Open Access
Publication channel's open availability : Open Access publication channel
Web address : https://doi.org/10.1016/j.ijcha.2025.101861
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/506490156
Self-archived copy's licence: CC BY
Self-archived copy's version: Publisher`s PDF
Background
Despite advancements in surgical techniques and perioperative care, postoperative bleeding and neurological complications remain significant concerns after bioprosthetic surgical aortic valve replacement (SAVR). The present study assessed the incidence of short-term and long-term major bleeding and strokes and their association with antithrombotic treatment after isolated bioprosthetic SAVR.
Methods
The CAREAVR study included 721 patients who underwent isolated bioprosthetic SAVR at four Finnish university hospitals between 2002 and 2014. The day-to-day information on short-term antithrombotic treatment was available from a subgroup including 227 patients.
Results
The median follow-up time was 4.9 (interquartile range 3.0–7.0) years. During the 30-day postoperative period, in the subgroup of 227 patients, 31 (13.7 %) patients experienced a major bleeding event, and 13 (5.7 %) patients a major stroke. A vast majority of the bleedings (80.6 %) occurred within two days after the surgery, and the tail effect of preoperative aspirin was present in 54.8 % of episodes, indicating unintentional antithrombotic effect. During the long-term follow-up (>30 days after the index surgery), major bleeding episodes occurred in 40 (5.5 %) patients, and 47 (6.5 %) patients experienced a major stroke. Overall, 23 (57.5 %) of the patients with major bleeding and 13 (27.7 %) of the patients experiencing major stroke were on OAC during the event.
Conclusion
The incidence of perioperative major bleeding was over two-fold compared to major stroke, the majority occurring during the tail effect of preoperatively used aspirin. During the long-term follow-up, the rates of stroke and major bleeds were similar, and most bleeding episodes occurred while on OAC.
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Funding information in the publication:
Dr. Björn received a research grant from the Maud Kuistila Memorial Foundation. Dr. Malmberg received travel grants and congress sponsorship (Abbot, Boston Lifesciences, Medtronic; Dr. Gunn received research grants from Turku University Research Foundation, Turku, Finland, the Clinical Research Fund (VTR) of Turku University Hospital, Turku Finland, and an unrestricted grant from Vifor Pharma; Dr. Nieminen received research grants from AbbVie and Metrdtronic, research fund of Helsinki and Uusimaa Hospital District, and lecture fees from AstraZeneca, Boehringer Ingelheim, Finnish Consulting Group (FCG), GE Healthcare, Medtronic, Orion and Sanofi; Dr Hartikainen received research grants from the Finnish Foundation for Cardiovascular Research, the VTR of Kuopio University Hospital, Kuopio, Finland, and lecture fees from Cardiome AG and Astra Zeneca; Dr. Airaksinen received research grants from the Finnish Foundation for Cardiovascular Research, the VTR of Turku University Hospital, Turku, Finland and lecture fees from Bayer and Boehringer Ingelheim; Dr. Kiviniemi received research grants from the EU (Moore4Medical, EIC patfinder Miracle), Academy of Finland (LAA-CLOSURE), Finnish Medical Foundation, The Finnish Foundation for Cardiovascular Research, Clinical Research Fund (EVO) of Turku University Hospital, Turku, Finland, Finnish Cardiac Society, the Emil Aaltonen Foundation, the Maud Kuistila Foundation. All other authors report no funding to declare.
