Key result
In patients undergoing transcatheter aortic valve interventions, bivalirudin compared to heparin significantly reduced myocardial infarction (OR 0.41; 95% CI 0.20-0.87) with no difference in mortality.
Why the study?
Does bivalirudin reduce mortality, myocardial infarction, or stroke compared to heparin in patients undergoing percutaneous transcatheter aortic valve interventions?
Meta-Analysis (n=1,690)
Does bivalirudin reduce mortality, myocardial infarction, or stroke compared to heparin in patients undergoing percutaneous transcatheter aortic valve interventions?
Bivalirudin may reduce the risk of myocardial infarction compared to heparin during transcatheter aortic valve interventions without increasing bleeding risk, though current evidence is limited.
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.
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Villablanca et al. (2017) conducted a meta-analysis in percutaneous transcatheter aortic valve interventions (PAVI) (n=1,690). Bivalirudin vs. Heparin was evaluated on all-cause mortality at 30 days (OR 0.97, 95% CI 0.62-1.52). In patients undergoing transcatheter aortic valve interventions, bivalirudin compared to heparin significantly reduced myocardial infarction (OR 0.41; 95% CI 0.20-0.87) with no difference in mortality.
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