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.
Resumen
Current periprocedural anticoagulation in transcatheter aortic valve replacement: could bivalirudin be an option? Rationale and design of the BRAVO 2/3 studies.
Por qué esto importa para la hirudoterapia
Esta revisión describe las limitaciones de la heparina no fraccionada para la anticoagulación periprocedimiento durante el reemplazo valvular aórtico transcatéter (TAVR) y explora el potencial de la bivalirudina como alternativa, describiendo el diseño de un ensayo clínico multicéntrico multinacional amplio en curso que compara la bivalirudina intravenosa con la heparina no fraccionada durante procedimientos TAVR utilizando criterios de valoración clínicos estandarizados. El artículo está indexado bajo el término MeSH "Hirudins" (Hirudinas), lo que refleja la relación farmacológica de la bivalirudina con la hirudina, lo que aporta un vínculo taxonómico tenue con el dominio de ASH. Sin embargo, el resumen en sí no discute en ningún momento sanguijuelas, hirudoterapia ni compuestos derivados de sanguijuela. Por lo tanto, la relevancia con el dominio de ASH es estrictamente indirecta, limitada a la evaluación clínica de un anticoagulante sintético con un linaje mecanístico a la inhibición de trombina derivada de sanguijuela.
Citación
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
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 28, 2026 · Última actualización del sitio: June 18, 2026