Periprocedural anticoagulation in transcatheter aortic valve replacement: Heparin vs bivalirudin

Transcatheter aortic valve replacement (TAVR) has emerged as an option for patients with severe aortic stenosis. Placement of Aortic Transcatheter Valves trial showed similar 2‑year outcomes in the context of mortality, symptoms reduction, and improved valve hemodynamics.[1] Currently, unfractionated heparin (UFH) is the standard of care for preprocedural anticoagulation during the TAVR. Another option available for anticoagulation is bivalirudin which has a shorter half‑life of 25 min as compared to 1.5 h of UFH but has no reversal agent available. Previously, many trials have been conducted to compare the safety and efficacy of UFH versus bivalirudin in patients who underwent percutaneous coronary intervention (PCI). The use of bivalirudin reduced the 30‑day mortality and net adverse cardiovascular events when compared to heparin plus glycoprotein IIb/IIIa inhibitors in patients with ST elevation myocardial infarction who underwent PCI.