Which patients undergoing transcatheter aortic valve implantation (TAVI) face the highest bleeding risk? A large cohort study from the Transfusion Requirements in Transcatheter Aortic Valve Implantation registry, published in Heart, evaluated the prevalence and prognostic value of the Valve Academic Research Consortium (VARC)-High Bleeding Risk (HBR) criteria.

The analysis included 8,464 patients treated across 18 European sites between 2007 and 2022. Investigators stratified patients into very high (23.2%), high (39.1%), moderate (24.5%), and low risk (13.1%) groups. In-hospital major or life-threatening bleeding occurred in 11.0% of low-risk patients, compared with 17.2%, 20.0%, and 22.2% of those at moderate, high, and very high risk, respectively (p<0.001). At two years, major adverse cardiovascular events ranged from 13.8% in the low-risk group to 25.4% in the very high–risk group (p<0.001). Mortality increased after bleeding (HR 1.71; 95% CI 1.50–1.95), particularly within the first three months (HR 2.88; 95% CI 2.33–3.56).

These findings show that VARC-HBR criteria stratify bleeding and cardiovascular risk in TAVI patients and support their use in guiding clinical decision-making.