Current periprocedural anticoagulation in transcatheter aortic valve replacement: Could bivalirudin be an option? Rationale and design of the BRAVO 2/3 studies

Ziad Sergie, Thierry Lefèvre, Eric Van Belle, Socrates Kakoulides, Usman Baber, Efthymios N. Deliargyris, Roxana Mehran, Eberhard Grube, Jochen Reinöhl, George D. Dangas

Research output: Contribution to journalArticlepeer-review

29 Scopus citations

Abstract

Transcatheter aortic valve replacement (TAVR) is considered an important option in the management of patients with critical aortic valve stenosis that are either inoperable or have a high surgical risk. Despite continued advances in the procedural aspects of TAVR and decreasing complications rates, the risks of major vascular complications and stroke remain significant, which may in turn confer worse clinical outcomes and impact morbidity and mortality. In this review, we outline certain limitations of the currently recommended periprocedural anticoagulation in TAVR, namely unfractionated heparin that is guided by activated clotting times and protamine use if the bleeding risk is high. We will explore the potential for bivalirudin in this setting, which has become a frontrunner in acute coronary syndrome management because of favorable pharmacokinetics and lower bleeding complications. Finally, we will describe an ongoing large multicenter multinational trial that compares intravenous bivalirudin to unfractionated heparin during TAVR procedures using standardized clinical endpoints.

Original languageEnglish
Pages (from-to)483-493
Number of pages11
JournalJournal of Thrombosis and Thrombolysis
Volume35
Issue number4
DOIs
StatePublished - May 2013

Keywords

  • Bivalirudin
  • Protamine
  • Transcatheter aortic valve replacement
  • Unfractionated heparin

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