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Valvular disease

Bivalirudin versus heparin for the treatment of cerebral embolization post-TAVR

Nature Reviews Cardiology volume 13, page 442 (2016)Cite this article

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Cerebral embolization is a common complication of the transcatheter aortic valve replacement (TAVR) procedure, but pharmacological strategies for the prevention of cerebral emboli have not yet been established. Investigators of the prespecified MRI substudy of the BRAVO-3 randomized trial sought to compare bivalirudin with unfractionated heparin for reducing cerebral embolization in patients undergoing TAVR. The proportion of patients with ≥1 new cerebral emboli, detected by MRI, was not different between the bivalirudin and heparin treatment groups (65.5% vs 58.1%, P = 0.55). Furthermore, the total volume of emboli and the proportion of patients with a clinical neurological deficit at 48 hours and 30 days post-TAVR were also not different between the two treatment groups. “The BRAVO-3 MRI study confirms the high rate of clinically silent cerebral embolization after TAVR as reported in other trials, without demonstrating any benefit regarding procedural anticoagulation with bivalirudin versus heparin in reducing these events,” conclude the investigators.

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References

  1. Van Belle, E. et al. Cerebral embolization during transcatheter aortic valve replacement: the BRAVO-3 MRI study. J. Am. Coll. Cardiol. http://dx.doi.org/10.1016/j.jacc.2016.05.006 (2016)

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Authors
  1. Karina Huynh
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Huynh, K. Bivalirudin versus heparin for the treatment of cerebral embolization post-TAVR. Nat Rev Cardiol 13, 442 (2016). https://doi.org/10.1038/nrcardio.2016.91

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