DRUG
Bivalirudin
Bivalirudin is an anticoagulant that binds directly to thrombin in a bivalent and reversible fashion.
Status
Completed
Phase
Phase 3
Enrollment
803
Locations
33
Results
Posted
Publications
2
Study summary
The objective of this study is to assess the safety and efficacy of using bivalirudin instead of unfractionated heparin (UFH) in transcatheter aortic valve replacements (TAVR). The primary hypothesis of BRAVO 3 was that bivalirudin would reduce major bleeding compared with heparin in TAVR procedures. Results for all participants enrolled into the randomized trial (BRAVO 3) are presented.
Interventions
DRUG
Bivalirudin is an anticoagulant that binds directly to thrombin in a bivalent and reversible fashion.
DRUG
Unfractionated heparin is an anticoagulant.
Timeline
First posted
Jul 27, 2012
Study start
Oct 2012
Primary completion
Jun 2015
Study completion
Jun 2015
Results posted
Feb 27, 2017
Registry updated
Apr 7, 2017
Outcomes
Major Bleeding (BARC ≥3b) at 48 Hours or Before Hospital Discharge
Time frame · at 48 hours or discharge, whichever occurs first
Major bleeding (Bleeding Academic Research Consortium \[BARC\] type ≥3b) was defined as follows: * Bleeds that were evident clinically, or by laboratory or imaging results, which resulted in surgical intervention or administration of IV vasoactive drugs; overt bleeds with a hemoglobin drop of at least 5 grams per deciliter (g/dL); and bleeding that caused cardiac tamponade. * BARC 3c includes intracranial or intraocular bleeds that compromised vision. * BARC type 4 (Coronary Artery Bypass Grafting \[CABG\]-related bleeding) includes perioperative intracranial bleeding within 48 hours, bleeds that result in reoperation following closure of sternotomy for the purpose of controlling bleeding, bleeds that result in treatment with transfusion of ≥5 units of whole blood or packed red blood cells within a 48 hour period; and chest tube output ≥2 liters (L) within a 24-hour period. * BARC type 5, fatal bleeding, describes bleeds that directly result in death with no other cause.
Net Adverse Clinical Events (NACE) at up to 30 Days
Time frame · up to 30 days after procedure
The net adverse cardiac events (NACE) at 30 days is the composite of major adverse cardiovascular events (MACE) + major bleeding (BARC type ≥3b). The composite of MACE is defined as all-cause mortality, myocardial infarction (MI), and stroke. A participant was defined to have a composite event if the participant experienced at least 1 of the components. If the participant did not have any of the components, then he or she did not have the composite endpoint. If a participant had more than 1 of the components, he or she was only counted once in the determination of the total number of participants experiencing the composite endpoint.
NACE at 48 Hours or Before Hospital Discharge
Time frame · at 48 hours or before hospital discharge, whichever occurred earlier
NACE at 48 hours or before hospital discharge is the composite of major adverse cardiovascular events (MACE) + major bleeding (BARC type ≥3b). The composite of MACE is defined as all-cause mortality, MI, and stroke. A participant was defined to have a composite event if the participant experienced at least 1 of the components. If the participant did not have any of the components, then he or she did not have the composite endpoint. If a participant had more than 1 of the components, he or she was only counted once in the determination of the total number of participants experiencing the composite endpoint.
Major Adverse Cardiac Events (MACE) Including Death, Non-fatal MI, and Stroke
Time frame · at 48 hours or before hospital discharge, whichever occurred earlier, and at up to 30 days (±7 days)
The percentage of participants reporting a MACE overall and the individual components of MACE (including death, non-fatal MI, and stroke) are presented.
Major Bleeding According to Additional Scales (VARC, TIMI, GUSTO, ACUITY/HORIZONS)
Time frame · at 48 hours or hospital discharge, whichever occurred earlier, and at up to 30 days (±7 days) follow-up
Percentage of participants with major bleeding according to the following scales: * Valve Academic Research Consortium (VARC)=life threatening, disabling bleeding, or major bleeding * Thrombolysis in Myocardial Infarction (TIMI)=major bleeding * Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO)=severe or moderate * Acute Catheterization and Urgent Intervention Triage StrategY (ACUITY)/Harmonizing Outcomes with RevasculariZatiON and Stents (HORIZONS)=major bleeding
Transient Ischemic Attack
Time frame · at 48 hours or before hospital discharge, whichever occurred earlier, and at up to 30 days (±7 days)
The percentage of participants reporting transient ischemic attack is presented.
Acute Kidney Injury
Time frame · at 48 hours or hospital discharge, whichever occurred earlier, and at up to 30 days (±7 days) follow-up
The percentage of participants reporting acute kidney injury is presented.
Major Vascular Complications
Time frame · at 48 hours or before hospital discharge, whichever occurred earlier, and at up to 30 days (±7 days)
The percentage of participants reporting a major vascular complications as defined by VARC is presented.
Acquired Thrombocytopenia
Time frame · at 48 hours or before hospital discharge, whichever occurred earlier, and at up to 30 days (±7 days)
The percentage of participants reporting acquired thrombocytopenia is presented.
New Onset Atrial Fibrillation/Flutter
Time frame · at 48 hours or before hospital discharge, whichever occurred earlier, and at up to 30 days (±7 days)
The percentage of participants reporting new onset atrial fibrillation/flutter is presented.
Timing Effect on Bleeding Event Rate up to 48 Hours or Hospital Discharge
Time frame · Up to 48 hours after procedure or at hospital discharge (but also includes any subsequent hospitalizations)
The effect of timing on bleeding event rates (the percentage of participants with an incidence of major bleeding) is presented.
Bleeding BARC 3a, BARC Types 1 or 2, and TIMI Minor
Time frame · at 48 hours or hospital discharge, whichever occurred earlier, and at up to 30 days (±7 days) follow-up
The percentage of participants with moderate bleeding as defined by BARC 3a and minor bleeding as defined as BARC type 1 and 2 and TIMI minor is presented.
Eligibility
Inclusion Criteria: * Males and females, ≥18 years of age * High risk (Euroscore ≥18, or considered inoperable) for surgical aortic valve replacement * Undergoing TAVR via transfemoral arterial access * Provide written informed consent before initiation of any study related procedures Exclusion Criteria: * Any known contra-indication to the use of bivalirudin (except presence of severe renal impairment \[glomerular filtration rate (GFR) \<30 milliliters (mL)/minute\] since these participants will be included in the trial or UFH * Refusal to receive blood transfusion * Mechanical valve (any location) or mitral bioprosthetic valve * Extensive calcification of the common femoral artery, or minimal luminal diameter \<6.5 millimeters (mm) * Use of elective surgical cut-down for transfemoral access * Concurrent performance of percutaneous coronary intervention with TAVR * International normalized ratio (INR) ≥2 on the day of TAVR procedure or known history of bleeding diathesis * History of hemorrhagic stroke, intracranial hemorrhage, intracerebral mass or aneurysm, or arteriovenous malformation * Severe left ventricular dysfunction (left ventricular ejection fraction \<15%) * Severe aortic regurgitation or mitral regurgitation (4+) * Hemodynamic instability (for example, requiring inotropic or intra-aortic balloon pump support) within 2 hours of the procedure * Dialysis dependent * Administration of thrombolytics, glycoprotein IIb/IIIa inhibitors, or warfarin in the 3 days prior to the procedure * Acute myocardial infarction, major surgery, or any therapeutic cardiac procedure (other than balloon aortic valvuloplasty) within 30 days * Percutaneous coronary intervention within 30 days * Upper gastrointestinal or genitourinary bleed within 30 days * Stroke or transient ischemic attack within 30 days * Any surgery or biopsy within 2 weeks * Administration of: * UFH within 30 minutes of the procedure * Enoxaparin within 8 hours of the procedure * Fondaparinux or other low-molecular-weight heparins (LMWHs) within 24 hours of the procedure * Dabigatran, rivaroxaban, or other oral anti-Xa or antithrombin agent within 48 hours of the procedure * Thrombolytics, glycoprotein IIb/IIIa inhibitor, or warfarin within 72 hours of the procedure * Absolute contraindications or allergy that cannot be pre-medicated to iodinated contrast * Contraindications or allergy to aspirin or clopidogrel * Known or suspected pregnant women or nursing mothers. Women of child-bearing potential will be asked if they are pregnant and will be tested for pregnancy * Previous enrollment in this study * Treatment with other investigational drugs or devices within the 30 days preceding enrollment or planned use of other investigational drugs or devices before the primary endpoint of this study has been reached
Study locations
Canada · France · Germany · Italy · Netherlands · Switzerland · United Kingdom. Showing up to 24 locations stored in the fast local snapshot.
Montreal Heart Institute
Montreal, Quebec, Canada
St. Paul´s Hospital Providence Health Care
Vancouver, Canada
Clinique Pasteur, Unité de Cardiologie Interventionnelle
Toulouse, Cedex 3, France
CHU de Toulouse
Toulouse, Cedex 9, France
CHU Jean Minjoz, Service de Cardiologie
Besançon, France
Centre Hospitalier de Lyon
Bron, France
Department of Cardiology, CHRU Lille
Lille, France
Institut Hospitalier Jacques Cartier
Massy, France
Service de Cardiologie, Centre Hospitalo-Universitaire, Hôpital Charles-Nicolle
Rouen, France
University Heart Centre, Clinic of Inner Medicine 1 Cardiology
Jena, Lobeda Ost, Germany
Universitätsklinikum Bonn
Bonn, Germany
Klinikum links der Weser Bremen
Bremen, Germany
Elisabeth-Krankenhaus Essen
Essen, Germany
Freiburg University
Freiburg im Breisgau, Germany
Asklepios St. Georg Hamburg
Hamburg, Germany
Universitätsklinikum Hamburg-Eppendorf
Hamburg, Germany
Medizinische Hochschule Hannover
Hanover, Germany
Universität Leipzig - Herzzentrum GmbH
Leipzig, Germany
Universitätsmedizin der Johannes Gutenberg-Universitat Mainz
Mainz, Germany
LMU Munich, Klinikum der Universität München
Munich, Germany
Deutsches Herzzentrum München
München, Germany
Helios Heart Center Siegburg
Siegburg, Germany
Ferraroto Hospital, University of Catania
Catania, Italy
Ospedale San Raffaele U.O. Cardiologia Interventistica
Milan, Italy
Publications
Related trials
Duke University · Coronavirus Infection (COVID-19) · Pulmonary Arterial Hypertension
Not applicable
Recruiting
5,000
2026-07
Sydney Local Health District · Extracorporeal Membrane Oxygenation Complication
Phase 2
Recruiting
80
2026-05
Xiaotong Hou · Extracorporeal Membrane Oxygenation Complication
Not applicable
Recruiting
154
2026-04
Shenyang Northern Hospital · Percutaneous Coronary Intervention · High Bleeding Risk
Phase 4
Not yet recruiting
5,270
2026-02
Stanford University · Heart Failure · Cardiogenic Shock
Phase 2
Recruiting
50
2026-01
NYU Langone Health · Coronary Microvascular Disease · Ischemic Heart Disease
Not applicable
Active, not recruiting
206
2025-11
Shenyang Northern Hospital · ST Elevation Myocardial Infarction
Not applicable
Completed
6,016
2025-08
Peking University First Hospital · Coronary Microvascular Dysfunction
Phase 4
Recruiting
70
2025-08
Related PeptideStat pages
Research pages describe evidence. Vendor pages, where available, describe independently tracked research-product listings and are not clinical recommendations.