Abstract
While the main gist of research pertaining to TAVR procedure involves improvement of existing valve technologies, lower size delivery systems and post-procedure antithrombotic therapy, the optimal intra-procedure anticoagulation has not been sufficiently defined. Peri-procedural complications such as cerebrovascular events and bleeding are largely associated with the safety and efficacy of anticoagulation regimen. Current guidelines advocate the use of heparin for anticoagulation with a target activated clotting time ≥300 seconds and careful protamine infusion in patients with high estimated bleeding risk. In this setting bivalirudin, devoid of all undesirable properties of unfractionated heparin such as highly variable elimination time and heparin-induced thrombocytopenia, may represent an alternative option in the interventionist’s armamentarium. Initial experience with bivalirudin has been encouraging as shown in two observational studies in the context of TAVR and balloon aortic valvuloplasty. The need for bleeding events reduction is particularly pronounced in this population that exhibits an inherent high bleeding risk due to platelet and von Willebrand factor dysfunction. Nevertheless, data from randomized studies are needed to establish bivalirudin role during TAVR procedure.
Keywords: Transcatheter aortic valve replacement, procedural anticoagulation, bivalirudin
Current Pharmaceutical Design
Title:Bivalirudin or Heparin Treatment During Transcatheter Valve Interventions: Where are we Now?
Volume: 22 Issue: 13
Author(s): Ioannis Mastoris and George D. Dangas
Affiliation:
Keywords: Transcatheter aortic valve replacement, procedural anticoagulation, bivalirudin
Abstract: While the main gist of research pertaining to TAVR procedure involves improvement of existing valve technologies, lower size delivery systems and post-procedure antithrombotic therapy, the optimal intra-procedure anticoagulation has not been sufficiently defined. Peri-procedural complications such as cerebrovascular events and bleeding are largely associated with the safety and efficacy of anticoagulation regimen. Current guidelines advocate the use of heparin for anticoagulation with a target activated clotting time ≥300 seconds and careful protamine infusion in patients with high estimated bleeding risk. In this setting bivalirudin, devoid of all undesirable properties of unfractionated heparin such as highly variable elimination time and heparin-induced thrombocytopenia, may represent an alternative option in the interventionist’s armamentarium. Initial experience with bivalirudin has been encouraging as shown in two observational studies in the context of TAVR and balloon aortic valvuloplasty. The need for bleeding events reduction is particularly pronounced in this population that exhibits an inherent high bleeding risk due to platelet and von Willebrand factor dysfunction. Nevertheless, data from randomized studies are needed to establish bivalirudin role during TAVR procedure.
Export Options
About this article
Cite this article as:
Mastoris Ioannis and D. Dangas George, Bivalirudin or Heparin Treatment During Transcatheter Valve Interventions: Where are we Now?, Current Pharmaceutical Design 2016; 22 (13) . https://dx.doi.org/10.2174/1381612822666151208122005
DOI https://dx.doi.org/10.2174/1381612822666151208122005 |
Print ISSN 1381-6128 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-4286 |
Call for Papers in Thematic Issues
"Tuberculosis Prevention, Diagnosis and Drug Discovery"
The Nobel Prize-winning discoveries of Mycobacterium tuberculosis and streptomycin have enabled an appropriate diagnosis and an effective treatment of tuberculosis (TB). Since then, many newer diagnosis methods and drugs have been saving millions of lives. Despite advances in the past, TB is still a leading cause of infectious disease mortality ...read more
Current Pharmaceutical challenges in the treatment and diagnosis of neurological dysfunctions
Neurological dysfunctions (MND, ALS, MS, PD, AD, HD, ALS, Autism, OCD etc..) present significant challenges in both diagnosis and treatment, often necessitating innovative approaches and therapeutic interventions. This thematic issue aims to explore the current pharmaceutical landscape surrounding neurological disorders, shedding light on the challenges faced by researchers, clinicians, and ...read more
Emerging and re-emerging diseases
Faced with a possible endemic situation of COVID-19, the world has experienced two important phenomena, the emergence of new infectious diseases and/or the resurgence of previously eradicated infectious diseases. Furthermore, the geographic distribution of such diseases has also undergone changes. This context, in turn, may have a strong relationship with ...read more
Melanoma and Non-Melanoma Skin Cancer Treatment: Standard of Care and Recent Advances
In this thematic issue, we aim to provide a standard of care of the diagnosis and treatment of melanoma and non-melanoma skin cancer. The editor will invite authors from different countries who will write review articles of melanoma and non-melanoma skin cancers. The Diagnosis, Staging, Surgical Treatment, Non-Surgical Treatment all ...read more
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
- Announcements
Related Articles
-
Healing the Diabetic Heart: Modulation of Cardiometabolic Syndrome through Peroxisome Proliferator Activated Receptors (PPARs)
Current Molecular Pharmacology Hypolipidaemic Drug Treatment: Yesterday is Not Gone Yet, Today is Challenging and Tomorrow is Coming Soon; let us Combine them all
Current Pharmaceutical Design Effects of Mesenchymal Stromal Cells on Diabetic Cardiomyopathy
Current Pharmaceutical Design Cardiac Amyloidosis Responding to Bortezomib: Case Report and Review of Literature
Current Cardiology Reviews Editorial [Hot Topic:Translating Clinical Evidence into the Practice of Diabetes Care (Guest Editor: Richard W. Grant Contents)]
Current Diabetes Reviews Nutritional Antioxidants Mechanisms of Action, Analyses of Activities and Medical Applications
Current Medicinal Chemistry - Immunology, Endocrine & Metabolic Agents Heart Disease Induced by AAS Abuse, Using Experimental Mice/Rats Models and the Role of Exercise-Induced Cardiotoxicity
Mini-Reviews in Medicinal Chemistry Predictive In Silico Studies of Human 5-hydroxytryptamine Receptor Subtype 2B (5-HT2B) and Valvular Heart Disease
Current Topics in Medicinal Chemistry Role of Nut Consumption in the Management of Cognitive Decline - A Mini-Review
Current Alzheimer Research A Comparative Assessment of Metabolic Syndrome and its Association with Vitamin D and Other Risk Factors in Type 2 Diabetes Mellitus Patients
Current Diabetes Reviews Studies on Drug-Drug Interactions, Presence and Absence of Diazepam (Site-II Specific Probe) Propranolol and Amitriptyline at Binding Sites of Bovine Serum Albumin
Current Drug Therapy Molecular Mechanisms of Inflammation. Anti-Inflammatory Benefits of Virgin Olive Oil and the Phenolic Compound Oleocanthal
Current Pharmaceutical Design Non-pharmacological Strategies Against Systemic Inflammation: Molecular Basis and Clinical Evidence
Current Pharmaceutical Design Role of AGEs-RAGE System in Cardiovascular Disease
Current Pharmaceutical Design Nutritional and Therapeutic Potential of Spirulina
Current Pharmaceutical Biotechnology Determinants of Paraoxonase 1 Status: Genes, Drugs and Nutrition
Current Medicinal Chemistry Validity of Oxygen-Ozone Therapy as Integrated Medication Form in Chronic Inflammatory Diseases
Cardiovascular & Hematological Disorders-Drug Targets The Heart Metabolism: Pathophysiological Aspects in Ischaemia and Heart Failure
Current Pharmaceutical Design Medicinal Plants with Multiple Effects on Cardiovascular Diseases: A Systematic Review
Current Pharmaceutical Design MTHFR Gene Polymorphism and Diabetic Retinopathy
Current Diabetes Reviews