Impact of coronary artery disease on clinical outcomes after TAVR: Insights from the BRAVO-3 randomized trial
Randomized controlled trial published in Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (2023)
Abstract
OBJECTIVE: To determine the prognostic impact of coronary artery disease (CAD) in patients randomized to bivalirudin or unfractionated heparin (UFH) during transcatheter aortic valve replacement (TAVR). BACKGROUND: CAD is a common comorbidity among patients undergoing TAVR and studies provide conflicting data on its prognostic impact. METHODS: The Bivalirudin on Aortic Valve Intervention Outcomes-3 (BRAVO-3) randomized trial compared the use of bivalirudin versus UFH in 802 high-surgical risk patients undergoing transfemoral TAVR for severe symptomatic aortic stenosis. Patients were stratified according to the presence or absence of history of CAD as well as periprocedural anticoagulation. The coprimary endpoints were net adverse cardiac events (NACE; a composite of all-cause mortality, myocardial infarction, stroke, or major bleeding) and major Bleeding Academic Research Consortium (BARC) bleeding ≥3b at 30 days postprocedure. RESULTS: Among 801 patients, 437 (54.6%) had history of CAD of whom 223 (51.0%) received bivalirudin. There were no significant differences in NACE (adjusted odds ratio [OR]: 1.04; 95% confidence interval [CI]: 0.69-1.58) or BARC ≥ 3b bleeding (adjusted OR: 0.84; 95% CI: 0.51-1.39) in patients with vs without CAD at 30 days. Among CAD patients, periprocedural use of bivalirudin was associated with similar NACE (OR: 0.80; 95% CI: 0.47-1.35) and BARC ≥ 3b bleeding (OR: 0.64; 95% CI: 0.33-1.25) compared with UFH, irrespective of history of CAD (p-interaction = 0.959 for NACE; p-interaction = 0.479 for major bleeding). CONCLUSION: CAD was not associated with a higher short-term risk of NACE or major bleeding after TAVR. Periprocedural anticoagulation with bivalirudin did not show any advantage over UFH in patients with and without CAD.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
To determine the prognostic impact of coronary artery disease (CAD) in patients randomized to bivalirudin or unfractionated heparin (UFH) during transcatheter aortic valve replacement (TAVR).
Why This Matters for Hirudotherapy
This analysis of the BRAVO-3 randomized trial (801 patients undergoing transfemoral TAVR) examined whether coronary artery disease (CAD) affected 30-day outcomes and whether periprocedural bivalirudin versus unfractionated heparin differed by CAD status, finding no significant differences in net adverse cardiac events or major bleeding. For ASH, this is relevant because bivalirudin is a direct thrombin inhibitor derived from hirudin, the anticoagulant in medicinal leech saliva, so comparative outcomes data on a leech-derived therapeutic helps characterize the translational footprint of the leech secretome in modern procedural anticoagulation. An honest caveat: the trial was not designed to detect CAD-by-treatment interactions, and these findings concern a pharmaceutical hirudin analog in a specific procedural context — not leech therapy itself, and not proof of differential efficacy of leech-derived versus conventional anticoagulants.
Citation
Impact of coronary artery disease on clinical outcomes after TAVR: Insights from the BRAVO-3 randomized trial
Feldman D et al. · Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, 2023
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