Current periprocedural anticoagulation in transcatheter aortic valve replacement: could bivalirudin be an option? Rationale and design of the BRAVO 2/3 studies.
Research article published in Journal of thrombosis and thrombolysis (2013)
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.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Current periprocedural anticoagulation in transcatheter aortic valve replacement: could bivalirudin be an option? Rationale and design of the BRAVO 2/3 studies.
Why This Matters for Hirudotherapy
This review outlines limitations of unfractionated heparin for periprocedural anticoagulation during transcatheter aortic valve replacement (TAVR) and explores the potential of bivalirudin as an alternative, describing the design of an ongoing large multicenter multinational trial comparing intravenous bivalirudin to unfractionated heparin during TAVR procedures using standardized clinical endpoints. The article is indexed under the MeSH term "Hirudins," reflecting bivalirudin's pharmacological relationship to hirudin, which provides a tenuous taxonomic link to ASH's domain. However, the abstract itself does not discuss leeches, hirudotherapy, or leech-derived compounds at any point. Relevance to ASH's domain is therefore strictly indirect, limited to the clinical evaluation of a synthetic anticoagulant with a mechanistic lineage to leech-derived thrombin inhibition.
Citation
Current periprocedural anticoagulation in transcatheter aortic valve replacement: could bivalirudin be an option? Rationale and design of the BRAVO 2/3 studies.
Sergie et al. · Journal of thrombosis and thrombolysis, 2013
Added to ASH library: May 28, 2026 · Site last updated: June 18, 2026