Bivalirudin versus heparin in patients undergoing percutaneous transcatheter aortic valve interventions: A systematic review and meta-analysis

Pedro A. Villablanca, Rasha Al-Bawardy, Divyanshu Mohananey, Carola Maraboto, Michael Weinreich, Tanush Gupta, David F. Briceno, Harish Ramakrishna

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Bivalirudin may be an effective anticoagulation alternative to heparin as anticoagulant agent in percutaneous transcatheter aortic valve interventions (PAVI). We aimed to compare safety and efficacy of bivalirudin versus heparin as the procedural anticoagulant agent in patients undergoing PAVI. Methods: We conducted an electronic database search of all published data. The primary efficacy endpoints were all-cause mortality, cardiovascular mortality, myocardial infarction, and stroke. Safety endpoints include major and life-threatening bleed according to VARC and BARC bleeding, blood transfusion, vascular complications, and acute kidney injury. Odds ratios (OR) and 95% confidence intervals (CI) computed using the Mantel-Haenszel method. Results: Three studies (n=1690 patients) were included, one randomized trial and two observational studies. There was a significant difference favoring bivalirudin over heparin for myocardial infarction (OR 0.41, 95%CI 0.20-0.87). There was no significant difference in all-cause mortality at 30 days (OR 0.97, 95%CI 0.62-1.52), cardiovascular mortality (OR 1.03, 95%CI 0.52-2.05), stroke (OR 1.23, 95%CI 0.62-2.46), vascular complications (OR 0.96, 95%CI 0.70-1.32), acute kidney injury (OR 1.03, 95%CI 0.53-2.00), blood transfusion (OR 0.67, 95% CI 0.45-1.01), major and life-threatening bleed (OR 0.74, 95%CI 0.37-1.49), and BARC bleeding (OR 0.52, 95%CI 0.23-1.18). Conclusions: In patient undergoing aortic valve interventions, no difference was seen between the use of bivalirudin and heparin as the procedural anticoagulant agent, except for a significant lower myocardial infarction events when bivalirudin was used. Further large randomized trials are needed to confirm current results.

Original languageEnglish (US)
JournalJournal of Interventional Cardiology
DOIs
StateAccepted/In press - 2017

Fingerprint

Aortic Valve
Heparin
Meta-Analysis
Odds Ratio
Confidence Intervals
Anticoagulants
Mortality
Myocardial Infarction
Acute Kidney Injury
Blood Transfusion
Blood Vessels
Stroke
bivalirudin
Hemorrhage
Safety
Observational Studies
Databases

Keywords

  • Aortic valve
  • Bivalirudin
  • Heparin
  • Percutaneous

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Bivalirudin versus heparin in patients undergoing percutaneous transcatheter aortic valve interventions : A systematic review and meta-analysis. / Villablanca, Pedro A.; Al-Bawardy, Rasha; Mohananey, Divyanshu; Maraboto, Carola; Weinreich, Michael; Gupta, Tanush; Briceno, David F.; Ramakrishna, Harish.

In: Journal of Interventional Cardiology, 2017.

Research output: Contribution to journalArticle

Villablanca, Pedro A. ; Al-Bawardy, Rasha ; Mohananey, Divyanshu ; Maraboto, Carola ; Weinreich, Michael ; Gupta, Tanush ; Briceno, David F. ; Ramakrishna, Harish. / Bivalirudin versus heparin in patients undergoing percutaneous transcatheter aortic valve interventions : A systematic review and meta-analysis. In: Journal of Interventional Cardiology. 2017.
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T1 - Bivalirudin versus heparin in patients undergoing percutaneous transcatheter aortic valve interventions

T2 - A systematic review and meta-analysis

AU - Villablanca, Pedro A.

AU - Al-Bawardy, Rasha

AU - Mohananey, Divyanshu

AU - Maraboto, Carola

AU - Weinreich, Michael

AU - Gupta, Tanush

AU - Briceno, David F.

AU - Ramakrishna, Harish

PY - 2017

Y1 - 2017

N2 - Background: Bivalirudin may be an effective anticoagulation alternative to heparin as anticoagulant agent in percutaneous transcatheter aortic valve interventions (PAVI). We aimed to compare safety and efficacy of bivalirudin versus heparin as the procedural anticoagulant agent in patients undergoing PAVI. Methods: We conducted an electronic database search of all published data. The primary efficacy endpoints were all-cause mortality, cardiovascular mortality, myocardial infarction, and stroke. Safety endpoints include major and life-threatening bleed according to VARC and BARC bleeding, blood transfusion, vascular complications, and acute kidney injury. Odds ratios (OR) and 95% confidence intervals (CI) computed using the Mantel-Haenszel method. Results: Three studies (n=1690 patients) were included, one randomized trial and two observational studies. There was a significant difference favoring bivalirudin over heparin for myocardial infarction (OR 0.41, 95%CI 0.20-0.87). There was no significant difference in all-cause mortality at 30 days (OR 0.97, 95%CI 0.62-1.52), cardiovascular mortality (OR 1.03, 95%CI 0.52-2.05), stroke (OR 1.23, 95%CI 0.62-2.46), vascular complications (OR 0.96, 95%CI 0.70-1.32), acute kidney injury (OR 1.03, 95%CI 0.53-2.00), blood transfusion (OR 0.67, 95% CI 0.45-1.01), major and life-threatening bleed (OR 0.74, 95%CI 0.37-1.49), and BARC bleeding (OR 0.52, 95%CI 0.23-1.18). Conclusions: In patient undergoing aortic valve interventions, no difference was seen between the use of bivalirudin and heparin as the procedural anticoagulant agent, except for a significant lower myocardial infarction events when bivalirudin was used. Further large randomized trials are needed to confirm current results.

AB - Background: Bivalirudin may be an effective anticoagulation alternative to heparin as anticoagulant agent in percutaneous transcatheter aortic valve interventions (PAVI). We aimed to compare safety and efficacy of bivalirudin versus heparin as the procedural anticoagulant agent in patients undergoing PAVI. Methods: We conducted an electronic database search of all published data. The primary efficacy endpoints were all-cause mortality, cardiovascular mortality, myocardial infarction, and stroke. Safety endpoints include major and life-threatening bleed according to VARC and BARC bleeding, blood transfusion, vascular complications, and acute kidney injury. Odds ratios (OR) and 95% confidence intervals (CI) computed using the Mantel-Haenszel method. Results: Three studies (n=1690 patients) were included, one randomized trial and two observational studies. There was a significant difference favoring bivalirudin over heparin for myocardial infarction (OR 0.41, 95%CI 0.20-0.87). There was no significant difference in all-cause mortality at 30 days (OR 0.97, 95%CI 0.62-1.52), cardiovascular mortality (OR 1.03, 95%CI 0.52-2.05), stroke (OR 1.23, 95%CI 0.62-2.46), vascular complications (OR 0.96, 95%CI 0.70-1.32), acute kidney injury (OR 1.03, 95%CI 0.53-2.00), blood transfusion (OR 0.67, 95% CI 0.45-1.01), major and life-threatening bleed (OR 0.74, 95%CI 0.37-1.49), and BARC bleeding (OR 0.52, 95%CI 0.23-1.18). Conclusions: In patient undergoing aortic valve interventions, no difference was seen between the use of bivalirudin and heparin as the procedural anticoagulant agent, except for a significant lower myocardial infarction events when bivalirudin was used. Further large randomized trials are needed to confirm current results.

KW - Aortic valve

KW - Bivalirudin

KW - Heparin

KW - Percutaneous

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