Clinical ResearchBivalirudin vs Heparin in Patients Who Undergo Transcatheter Aortic Valve Implantation
Section snippets
Patients
From November 2007 until October 2012, 461 consecutive patients (mean age 81.2 ± 6.7 years) underwent a TAVI because of symptomatic high-grade aortic stenosis at the Medizinische Klinik und Poliklinik I, University of Munich, Munich, Germany. Two different valve types were implanted: Medtronic CoreValve prosthesis (n = 302 patients) and Edwards Sapien XT prosthesis (n = 159). The decision about TAVI was made by the multidisciplinary heart board considering the patients' age, comorbidities, and
Results
Of the 461 patients included in this retrospective analysis, 339 patients (73.5%) received bivalirudin, and 122 patients (26.5%) received UFH peri-TAVI. No differences were observed between the 2 groups regarding baseline characteristics except for a lower incidence of PCI > 30 days before TAVI in the bivalirudin group (19.8% vs 36.1% in the UFH group; P < 0.001; Table 1). The most frequently implanted prosthesis was the Medtronic CoreValve in 53.1% of patients in the bivalirudin group and 100%
Discussion
In this analysis of a large number of patients who underwent TAVI and received either bivalirudin or UFH, there was no difference regarding life-threatening, or major or minor bleeding complications using the VARC 2 bleeding definitions. We found no difference between bivalirudin and heparin with respect to 72-hour and 30-day mortality (cardiovascular and all cause) or early 30-day safety.
The study extends previous findings with bivalirudin used as an anticoagulant in patients who underwent
Acknowledgements
Philipp Lange, Martin Greif, and Dario Bongiovanni contributed equally to this work.
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Cited by (13)
Bivalirudin as a Systemic Anticoagulant and Flush Solution Additive for Sequential Mitral and Tricuspid Valve Percutaneous Edge-to-Edge Repair in a Patient With Heparin-Induced Thrombocytopenia
2022, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :Similarly, bivalirudin was noninferior to heparin for transcatheter aortic valve replacement (TAVR), with no differences in net adverse clinical events at 30 days.21 These results were supported by additional research in TAVR patients that demonstrated a similar safety and efficacy profile for bivalirudin compared with heparin.25 One case report described the successful use of argatroban as the primary anticoagulant for TAVR in a patient with HIT.26
Bivalirudin anticoagulation for minimal invasive transapical transcatheter aortic valve replacement in a patient with antiphospholipid antibodies
2016, Journal of Clinical AnesthesiaCitation Excerpt :When compared with heparin, bivalirudin has been shown to decrease the risk of bleeding in this indication [1]. This observation of a decrease of hemorrhagic complications when using bivalirudin anticoagulation was confirmed in a recent large registry study for balloon aortic valvuloplasty; however, results for transfemoral TAVR did not show significant differences in this regard [3,4]. Viewing these conditions, we deemed bivalirudin to be the anticoagulant of choice in our patient.
Bivalirudin Versus Heparin Anticoagulation in Transcatheter Aortic Valve Replacement the Randomized BRAVO-3 Trial
2015, Journal of the American College of CardiologyCitation Excerpt :In this first randomized trial of TAVR pharmacology, the dosage experience of coronary interventions was largely utilized; in this context, our findings suggest correct dosing for bivalirudin (i.e., no obvious underdose or overdose of study drug), which was sufficient to prevent ischemic events without increasing the risk of bleeding compared with heparin despite the unavailability of a bivalirudin antidote. A similar dosage was also used in 2 nonrandomized, smaller cohort studies with bivalirudin in valvuloplasty and TAVR (13,14). The composite of major adverse cardiovascular events is an important endpoint for all cardiac interventions, especially high-risk procedures such as TAVR.
Impact of anemia on short-term outcomes after TAVR: A subgroup analysis from the BRAVO-3 randomized trial
2021, Catheterization and Cardiovascular InterventionsHeparin-Induced Thrombocytopenia
2020, Cardiac Surgery: A Complete Guide
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