HealthDay News — Cerebral embolization occurs in a similar proportion of patients receiving procedural anticoagulation with bivalirudin and heparin during transcatheter aortic valve replacement (TAVR), according to a study published in the Journal of the American College of Cardiology to coincide with EuroPCR 2016, held from May 17 to 20 in Paris.

Eric Van Belle, MD, PhD, from CHRU Lille in France, and colleagues examined the proportion of patients with new cerebral embolus after TAVR. Sixty patients from the BRAVO-3 randomized trial, which compared bivalirudin (29 patients) with unfractionated heparin (31 patients), were imaged with brain magnetic resonance imaging (MRI) after TAVR.

The researchers observed no significant difference between the groups in the proportion of patients with 1 or more new cerebral embolus on MRI (65.5% in the bivalirudin group vs 58.1% in the heparin group; P = 0.55). No significant between-group differences were seen in the number of emboli/patient (P = 0.08) or total volume of emboli (P = 0.86), or in the proportion of patients with a clinical neurological deficit at 48 hours or 30 days.

“This study documented cerebral embolization in nearly two-thirds of patients during contemporary TAVR,” the authors write. “There were no significant differences in cerebral embolization measures for intraprocedural anticoagulation during TAVR with bivalirudin vs heparin.”

Several authors disclosed financial ties to The Medicines Company, which funded the study.


Van Belle E, Hengstenberg C, Lefevre T, et al. Cerebral Embolization During Transcatheter Aortic Valve Replacement: The BRAVO-3 MRI Study. J Am Coll Cardiol. 2016; doi:10.1016/j.jacc.2016.05.006.