PMID- 22562912
OWN - NLM
STAT- MEDLINE
DCOM- 20120904
LR  - 20161125
IS  - 1557-2501 (Electronic)
IS  - 1042-3931 (Linking)
VI  - 24
IP  - 5
DP  - 2012 May
TI  - Clinical safety of bivalirudin in patients undergoing carotid stenting.
PG  - 202-5
AB  - BACKGROUND: Prior to June 2011, carotid artery stenting (CAS) had been limited to 
      patients deemed high risk for surgical revascularization due to medical or 
      anatomic reasons. Intraprocedural anticoagulation for CAS has traditionally been 
      carried out with unfractionated heparin (UFH). The direct thrombin inhibitor 
      bivalirudin has emerged as a possible alternative choice for anticoagulation in 
      this patient population. In patients undergoing coronary interventions, 
      bivalirudin has been shown in large prospective analysis to reduce major adverse 
      events and hemorrhagic complications (TIMI major bleeding rates, 0.6%-3.1%; TIMI 
      minor bleeding rates, 1.3%-3.7%). As of now, the safety and efficacy of 
      bivalirudin for use during carotid stenting has not been rigorously evaluated. To 
      date, the published evidence in favor of bivalirudin for CAS exists in small 
      retrospective analyses and two prospective studies. METHODS: We present a 
      retrospective analysis of 331 patients with a total of 365 carotid artery lesions 
      undergoing CAS between February 2007 and September 2010. The procedures were 
      performed by five experienced operators from four separate sites within the same 
      metropolitan area. Patients were included who received bivalirudin as the 
      anticoagulation strategy and underwent CAS. The primary endpoints of the study 
      were 30-day incidence of death, stroke, TIMI major bleeding (defined as >/=5 g/dL 
      Hgb drop or intracranial hemorrhage), TIMI minor bleeding (defined as >/=3 g/dL Hgb 
      drop), and blood transfusion. All data were collected by retrospective chart 
      review. RESULTS: A total of 365 CAS procedures were performed. There were no 
      deaths, strokes, or TIMI major bleeds. There was a 2.19% incidence of TIMI minor 
      bleeding (8/365) and a 1.64% rate of blood transfusion (6/365). CONCLUSIONS: In 
      our patient population, the major endpoints of stroke, death, MI, major and minor 
      bleeding rates were well within those previously reported overall for carotid 
      artery revascularization. Hence, we conclude that bivalirudin may be safe for use 
      in CAS procedures with a safety profile similar to that validated in percutaneous 
      coronary interventions.
FAU - Cogar, Bryan D
AU  - Cogar BD
AD  - Integris Baptist Medical Center, University of Oklahoma, Oklahoma City, Oklahoma 
      73112, USA.
FAU - Wayangankar, Siddharth A
AU  - Wayangankar SA
FAU - Abu-Fadel, Mazen
AU  - Abu-Fadel M
FAU - Hennebry, Thomas A
AU  - Hennebry TA
FAU - Ghani, Mohammad K
AU  - Ghani MK
FAU - Kipperman, Robert M
AU  - Kipperman RM
FAU - Chrysant, George S
AU  - Chrysant GS
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PL  - United States
TA  - J Invasive Cardiol
JT  - The Journal of invasive cardiology
JID - 8917477
RN  - 0 (Antithrombins)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Recombinant Proteins)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Aged
MH  - Angioplasty, Balloon/*methods
MH  - Antithrombins/*therapeutic use
MH  - Carotid Arteries/diagnostic imaging
MH  - Carotid Stenosis/diagnostic imaging/*therapy
MH  - Combined Modality Therapy
MH  - Female
MH  - Hirudins
MH  - Humans
MH  - Male
MH  - Peptide Fragments/*therapeutic use
MH  - Radiography
MH  - Recombinant Proteins/therapeutic use
MH  - Recurrence
MH  - Retrospective Studies
MH  - Stents
EDAT- 2012/05/09 06:00
MHDA- 2012/09/05 06:00
CRDT- 2012/05/08 06:00
PHST- 2012/05/08 06:00 [entrez]
PHST- 2012/05/09 06:00 [pubmed]
PHST- 2012/09/05 06:00 [medline]
PST - ppublish
SO  - J Invasive Cardiol. 2012 May;24(5):202-5.