title: Current periprocedural anticoagulation in transcatheter aortic valve replacement: could bivalirudin be an option? Rationale and design of the BRAVO 2/3 studies.
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.
authors.affiliation: Mount Sinai School of Medicine, New York, NY, USA.
authors.forename: Ziad
authors.initials: Z
authors.lastname: Sergie
authors.forename: Thierry
authors.initials: T
authors.lastname: Lefèvre
authors.forename: Eric
authors.initials: E
authors.lastname: Van Belle
authors.forename: Socrates
authors.initials: S
authors.lastname: Kakoulides
authors.forename: Usman
authors.initials: U
authors.lastname: Baber
authors.forename: Efthymios N
authors.initials: EN
authors.lastname: Deliargyris
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Eberhard
authors.initials: E
authors.lastname: Grube
authors.forename: Jochen
authors.initials: J
authors.lastname: Reinöhl
authors.forename: George D
authors.initials: GD
authors.lastname: Dangas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000991:Antithrombins / Q000627:therapeutic use*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D002986:Clinical Trials as Topic; D005260:Female; D006350:Heart Valve Prosthesis; D006629:Hirudins; D006801:Humans; D008297:Male; D010446:Peptide Fragments / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000627:therapeutic use
chemical_list: D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin
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