Bivalirudin Versus Heparin Anticoagulation in Transcatheter Aortic Valve Replacement

Dangas, George; Lefèvre, Thierry; Kupatt, Christian; Tchétché, Didier; Schäfer, Ulrich; Dumonteil, Nicolas; Webb, John G.; Colombo, Antonio; Windecker, Stephan; Berg, Jürrien M. ten; Hildick‐Smith, David; Mehran, Roxana; Boekstegers, Peter; Linke, Axel; Tron, Christophe; Belle, Éric Van; Asgar, Anita W.; Fach, Andreas; Jeger, Raban; Sardella, Gennaro; Hink, Hans Ulrich; Hüsser, Oliver; Grube, Eberhard; Deliargyris, Efthymios N.; Lechthaler, Ilknur; Bernstein, Debra; Wijngaard, Peter; Anthopoulos, Prodromos; Hengstenberg, Christian

doi:10.1016/j.jacc.2015.10.003

Cited by 112 publications

(63 citation statements)

References 22 publications

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“…In the BRAVO-3 trial on TAVI periprocedural pharmacotherapy, bivalirudin did not reduce the rates of major bleeding at 48 hours or net adverse cardiovascular events within 30 days as compared to UFH. 29) Patients in our cohort who underwent TAVI did not have a preexisting anemia. Subjects who were diagnosed with anemia were temporally disqualified from TAVI and the procedure was postponed after finding the reason for the anemia or after achieving an optimal hemoglobin level.…”

Section: Discussionmentioning

confidence: 99%

Association Between Blood Transfusions and 12-Month Mortality After Transcatheter Aortic Valve Implantation

Kleczyński¹,

Dziewierz²,

Bagieński³

et al. 2017

Int. Heart J.

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SummaryBlood transfusions are considered as an important predictor of adverse outcome in patients with severe aortic (AS) undergoing transcatheter aortic valve implantation (TAVI). We sought to investigate the association between blood transfusions and mortality after TAVI. We enrolled 101 consecutive patients with severe AS undergoing TAVI. Patients who required transfusion were defined as patients in whom at least one unit of packed red blood cells (PRBCs) was transfused in the perioperative period. Twelve-month outcomes were assessed based on Valve Academic Research Consortium definitions. A total of 28 (27.7%) patients required blood transfusion after TAVI. Baseline characteristics of the patients with and without a transfusion were similar. Median amount of PRBCs was 2 (interquartile range, 2-4). Twelvemonth all-cause mortality was higher in patients with than without a blood transfusion (39.3% versus 9.6%; P = 0.001). Importantly, the need for a blood transfusion after TAVI was an independent predictor of higher mortality rates after 12 months (hazard ratio (HR) 2.84 95%CI (1.06-7.63); P = 0.039; (HR for incomplete coronary revascularization 10.86, 95%CI 3.72-31.73; P < 0.001; HR for a history of stroke/TIA 3.93, 95%CI 1.39-11.07; P < 0.001). The duration of inhospital stay was longer in patients requiring transfusion (16.0 (14.0-22.0) versus 7.0 (7.0-11.5) days; P = 0.014). In conclusion, blood transfusions after TAVI were associated with higher mortality rates after 12 months, longer in-hospital stay, and were identified as an independent predictor of impaired clinical outcome. (Int Heart J 2017; 58: 50-55)

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Section: Discussionmentioning

confidence: 99%

Association Between Blood Transfusions and 12-Month Mortality After Transcatheter Aortic Valve Implantation

Kleczyński¹,

Dziewierz²,

Bagieński³

et al. 2017

Int. Heart J.

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“…Although bivalirudin group showed slightly better results in the number of major bleedings at 48 h (6.9% vs 9.0%, P = 0.27) and net adverse cardiovascular events at 30 d (14.4% vs 16.1%, P = 0.35), these results were not statistically significant. Authors concluded that UFH should be used during the procedure because of the lower cost[46]. …”

Section: Resultsmentioning

confidence: 99%

Safety, efficiency and cost effectiveness of Bivalirudin: A systematic review

Mehrzad

Tuktamyshov

Mehrzad

2017

WJC

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AIMTo review the early and more recent studies of Bivalirudin, to assess the safety, effectiveness, and cost benefits of this drug.METHODSLiterature search of MEDLINE and PubMed databases from 1990 to 2017 using keywords as “bivalirubin” and “angiomax”, combined with the words “safety”, “effectiveness”, “efficiency”, “side effects”, “toxicity”, “adverse effect”, and “adverse drug reaction”.RESULTSA total of 66 publications were reviewed. The changes in clinical practice and differences in clinical protocols make it difficult to do direct comparisons of studies among each other. However, most trials showed decreased bleeding complications with bivalirudin, although ischemic complications and mortality were mostly comparable, with some favor towards bivalirudin.CONCLUSIONBivalirudin and heparin are both acceptable options according to current ACA/AHA guidelines. Authors conclude however, that that due to bivalirudin safer bleeding profile, it should be the preferred medication for anticoagulation.

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“…The incidence of intra‐ or postprocedural bleeding may be affected by the anticoagulant chosen. The Effect of Bivalirudin on Aortic Valve Intervention Outcomes‐3 (BRAVO‐3 study) compared the incidence of bleeding between two of the anticoagulants most commonly used during TAVR . For patients with normal renal function (glomerular filtration rate ≥ 60 ml/minute) randomized to bivalirudin, a bolus of 0.75 mg/kg followed by a continuous infusion at a rate of 1.75 mg/kg/hour was administered.…”

Section: Pharmacologic Considerations For Patients Undergoing Tavrmentioning

confidence: 99%

Medication Management of Patients Undergoing Transcatheter Aortic Valve Replacement

2017

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Aortic stenosis (AS) is the most common form of valvular heart disease. A detailed diagnostic workup is necessary to promptly stage and classify disease severity to determine optimal management. Medical therapy and valvuloplasty are options that fail to delay or reverse disease progression. Surgical aortic valve replacement (SAVR) is curative but has significant limitations for some patient populations. A newer option, transcatheter aortic valve replacement (TAVR), has become more widely available to patients with intermediate‐ or high‐operative risk. Periprocedural medication management is imperative for successful valve implantation and to minimize adverse events. Stroke remains one of the most common complications of TAVR and is associated with increased mortality. Thus, intra‐ and postprocedural antithrombotic therapy is required, although the regimen that best minimizes thromboembolic events and bleeding complications has yet to be defined. Patients undergoing TAVR with comorbid conditions requiring oral anticoagulation or individuals who develop subvalvular thromboses pose unique challenges. Antiplatelet and anticoagulant therapy should be carefully balanced. This article summarizes key literature supporting the pharmacologic management of patients receiving TAVR.

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Bivalirudin Versus Heparin Anticoagulation in Transcatheter Aortic Valve Replacement

Cited by 112 publications

References 22 publications

Association Between Blood Transfusions and 12-Month Mortality After Transcatheter Aortic Valve Implantation

Association Between Blood Transfusions and 12-Month Mortality After Transcatheter Aortic Valve Implantation

Safety, efficiency and cost effectiveness of Bivalirudin: A systematic review

Medication Management of Patients Undergoing Transcatheter Aortic Valve Replacement

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