S1438 Reduction of Clinically Significant Gastrointestinal Bleeding After Aortic Valve Replacement

Introduction: Bleeding events are associated with increased early and late mortality among patients with aortic stenosis (AS). Prior retrospective studies have demonstrated that transcatheter aortic valve implantation (TAVI) reduces gastrointestinal (GI) bleeding episodes by up to 80% in patients with severe AS and angiodysplasia. However, the potential GI bleeding risk reduction in patients without documented angiodysplasia remains unclear. Methods: We conducted a retrospective cohort study using the TriNetX database. Adult patients diagnosed with AS between January 1, 2012, and December 31, 2024, were included. Patients with any history of cancer or neoplasm were excluded. Participants were categorized into 2 cohorts: those who underwent aortic valve replacement (AVR) and those who did not. The index date was defined as the date of AVR for the intervention group and the date of AS diagnosis for the comparator group. Propensity score matching was used to adjust for potential confounders, including demographics, comorbidities, medication use (e.g., statins, antiplatelets, anticoagulants), and relevant laboratory parameters. The primary outcome was the occurrence of GI bleeding, with secondary outcomes including need for blood transfusion, endoscopic evaluation, and nuclear red blood cell (RBC) scanning. Cox proportional hazards models were used to estimate hazard ratios (HRs) for outcomes. Results: After propensity score matching, 91,221 patients were included in each cohort. Mean age was similar between groups (AVR: 72.8 ± 12.3 years vs non-AVR: 72.6 ± 12.5 years), with comparable distributions. GI bleeding occurred in 6,594 AVR patients versus 7,955 non-AVR patients. AVR was associated with a significantly lower incidence of GI bleeding (HR 0.91; 95% CI: 0.88–0.94; P < 0.001) and a reduced mean number of GI bleeding events per patient (0.32 vs 0.45; P < 0.001). Secondary outcomes were also significantly reduced in the AVR group: blood transfusion (HR 0.80; 95% CI: 0.76–0.84), esophagogastroduodenoscopy (HR 0.89; 95% CI: 0.86–0.92), colonoscopy (HR 0.83; 95% CI: 0.80–0.86), and tagged RBC scan (HR 0.70; 95% CI: 0.64–0.76). Conclusion: This study showed aortic valve replacement was associated with a significantly lower incidence and overall burden of GI bleeding among patients with aortic stenosis and no documented angiodysplasia, compared to matched controls. These findings suggest a broader protective effect of AVR on GI bleeding beyond patients with angiodysplasia.