Author + information
- Anurag Bajaj1,
- Samir Pancholy2,
- Arjinder Sethi3,
- Pranjal Boruah4,
- Arpit Sothwal5,
- Qasim Malik6 and
- Gursukhmandeep Sidhu7
- 1The wright center for graduate medical education, scranton, Pennsylvania, United States
- 2The Wright Center For Graduate Medical Education., Scranton, Pennsylvania, United States
- 3St.Luke's cardiology associates, bethlehem, Pennsylvania, United States
- 4The Wright center for graduate medical education, Scranton, Pennsylvania, United States
- 5The Wright Center, scranton, Pennsylvania, United States
- 6The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, United States
- 7The wright center for graduate medical education, Scranton, Pennsylvania, United States
Transcatheter aortic valve replacement (TAVR) and Balloon aortic valvuloplasty (BAV) bears specific procedural risks, including bleeding, vascular complications and atheroembolism causing stroke. Heparin is frequently used during these procedures to prevent atheroembolic events. There is limited data on the efficacy of bivaliruin compared with heparin in patients undergoing TAVR and BAV. We aimed to evaluate the safety and efficacy of the periprocedural bivalirudin versus heparin for aortic valve interventions.
A systematic search of database, including, Pubmed, Web of Science, Google scholar and Cochrane Database were performed by two independent reviewers to identify relevant studies. Studies were included comparing “heparin” versus “bivalirudin” in patients undergoing TAVR or BAV for severe aortic stenosis (AS). The primary outcome was in-hospital major bleeding. Secondary outcomes were in-hospital major adverse cardiovascular events (MACE), in-hospital net adverse clinical events (NACE), in-hospital all cause mortality, major vascular complications, acute myocardial infarction (MI), stroke and acute kidney injury (AKI).
Three studies, including 1690 patients were included in the analysis. Overall, the incidence of major bleeding was 7.6% (6.5% in the bivalirudin group versus 9.2% in heparin group). The incidence of major bleeding was significantly less in the bivalirudin group as compared to heparin group (OR, 0.58 [CI 0.33, 0.99], I2=49%). The risk of NACE and MI were also significantly less in the bivalirudin group as compared to heparin group (NACE (OR, 0.68 [CI 0.48, 0.97], I2=26%), MI (OR 0.41 [0.18, 0.94], I2=0). There was no significant difference in in-hospital MACE (OR, 0.70 [CI 0.46, 1.07], I2=0%), mortality (OR, 0.81 [CI 0.46, 1.45], I2=0%), major vascular complications (OR, 0.95 [CI 0.6, 1.39]5, I2=0%), stroke (OR, 0.99 [CI 0.31, 3.17], I2=15%) and AKI (OR, 1.01 [CI 0.53, 1.90], I2=77%) between the two groups.
In patients undergoing aortic valve interventions for severe AS, bivalirudin compared with heparin is associated with better in-hospital clinical outcomes in terms of reduced risk of major bleeding, MI and NACE.
STRUCTURAL: Valvular Disease: Aortic