PMID- 20719465
OWN - NLM
STAT- MEDLINE
DCOM- 20110406
LR  - 20161125
IS  - 1097-6809 (Electronic)
IS  - 0741-5214 (Linking)
VI  - 52
IP  - 6
DP  - 2010 Dec
TI  - Heparin versus bivalirudin for carotid artery stenting using proximal 
      endovascular clamping for neuroprotection: results from a prospective randomized 
      study.
PG  - 1505-10
LID - 10.1016/j.jvs.2010.06.098 [doi]
AB  - BACKGROUND: General recommendations indicate that, during a carotid artery 
      stenting (CAS), sufficient unfractionated heparin (UFH) has to be given to 
      maintain the activated clotting time between 250 to 300 seconds. Bivalirudin use 
      is able to reduce postprocedural bleedings in percutaneous interventions when 
      compared with UFH. The study purpose was to evaluate, in a randomized study, the 
      safety and efficacy of bivalirudin versus heparin during CAS, using proximal 
      endovascular occlusion (PEO) as a distal protection device. METHODS: From January 
      2006 to December 2009, 220 patients undergoing CAS using PEO have been randomly 
      assigned to one of the study arms (control arm: 100 UI/kg UFH or bivalirudin arm: 
      0.75 mg/kg intravenous bolus and intraprocedural infusion at 1.75 mg/kg/h). 
      RESULTS: Procedural success was achieved in all the patients. No episodes of 
      intraprocedural thrombosis occurred. One major stroke occurred in the bivalirudin 
      arm, and two minor strokes occurred, one in each group. A significant difference 
      in the incidence of postprocedural bleedings was observed between the study 
      groups; bivalirudin use was associated with reduced number of bleedings according 
      to Thrombolysis In Myocardial Infarction criteria. CONCLUSIONS: The use of 
      bivalirudin should be considered a safe and effective anticoagulation regimen 
      during CAS, using PEO as a distal protection device. Bivalirudin use is 
      associated with a reduced incidence of bleedings.
CI  - Copyright (c) 2010 Society for Vascular Surgery. Published by Mosby, Inc. All 
      rights reserved.
FAU - Stabile, Eugenio
AU  - Stabile E
AD  - Invasive Cardiology Laboratory, Cardiology Division, Clinica Montevergine, 
      Mercogliano, Italy. geko50@hotmail.com
FAU - Sorropago, Giovanni
AU  - Sorropago G
FAU - Tesorio, Tullio
AU  - Tesorio T
FAU - Popusoi, Grigore
AU  - Popusoi G
FAU - Ambrosini, Vittorio
AU  - Ambrosini V
FAU - Mottola, Maria Teresa
AU  - Mottola MT
FAU - Biamino, Giancarlo
AU  - Biamino G
FAU - Rubino, Paolo
AU  - Rubino P
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20100817
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
RN  - 0 (Anticoagulants)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Recombinant Proteins)
RN  - 9005-49-6 (Heparin)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Aged
MH  - Anticoagulants/*therapeutic use
MH  - *Balloon Occlusion
MH  - Blood Loss, Surgical/prevention & control
MH  - *Carotid Artery, Internal
MH  - Carotid Stenosis/*surgery
MH  - *Endovascular Procedures
MH  - Female
MH  - Heparin/*therapeutic use
MH  - Hirudins
MH  - Humans
MH  - Male
MH  - Peptide Fragments/*therapeutic use
MH  - Recombinant Proteins/therapeutic use
MH  - *Stents
MH  - Stroke/*prevention & control
MH  - Thrombosis/prevention & control
MH  - Whole Blood Coagulation Time
EDAT- 2010/08/20 06:00
MHDA- 2011/04/07 06:00
CRDT- 2010/08/20 06:00
PHST- 2010/02/11 00:00 [received]
PHST- 2010/04/16 00:00 [revised]
PHST- 2010/06/05 00:00 [accepted]
PHST- 2010/08/20 06:00 [entrez]
PHST- 2010/08/20 06:00 [pubmed]
PHST- 2011/04/07 06:00 [medline]
AID - S0741-5214(10)01493-X [pii]
AID - 10.1016/j.jvs.2010.06.098 [doi]
PST - ppublish
SO  - J Vasc Surg. 2010 Dec;52(6):1505-10. doi: 10.1016/j.jvs.2010.06.098. Epub 2010 
      Aug 17.