PMID- 23532554
OWN - NLM
STAT- MEDLINE
DCOM- 20131028
LR  - 20220408
IS  - 1941-7632 (Electronic)
IS  - 1941-7640 (Linking)
VI  - 6
IP  - 2
DP  - 2013 Apr
TI  - Hemorrhagic and ischemic outcomes after bivalirudin versus unfractionated heparin 
      during carotid artery stenting: a propensity score analysis from the NCDR.
PG  - 131-8
LID - 10.1161/CIRCINTERVENTIONS.112.974857 [doi]
AB  - BACKGROUND: The direct thrombin inhibitor, bivalirudin, is associated with 
      similar efficacy and superior safety in patients undergoing percutaneous coronary 
      intervention. However, the role of direct thrombin inhibitors in carotid artery 
      stenting is not well defined. The objective of this study was to compare the 
      safety and effectiveness of bivalirudin and unfractionated heparin (UFH) for 
      carotid artery stenting. We hypothesized that bivalirudin would be associated 
      with less in-hospital postprocedure bleeding than UFH but similar rates of 
      in-hospital and 30-day ischemic outcomes. METHODS AND RESULTS: We compared the 
      incidence of in-hospital hemorrhagic and in-hospital/30-day ischemic outcomes 
      among patients in the CARE Registry who underwent carotid artery stenting between 
      May 2005 and March 2012 using bivalirudin or UFH. Propensity score matching was 
      used to obtain a balanced cohort of 3555 patients in each treatment group. 
      Patients treated with bivalirudin had a significantly lower incidence of bleeding 
      or hematoma requiring red blood cell transfusions (0.9% versus 1.5%; odds ratio, 
      0.57 [0.36-0.89]; P=0.01) when compared with UFH-treated patients. The incidence 
      of in-hospital and 30-day ischemic outcomes, including death, myocardial 
      infarction, stroke, transient ischemic attack, and the composite outcome, 
      death/myocardial infarction/stroke, did not differ significantly between groups. 
      CONCLUSIONS: Bivalirudin was associated with lower rates of hemorrhagic outcomes 
      compared with UFH during the index hospitalization for carotid artery stenting. 
      In-hospital and 30-day ischemic events were similar between the 2 groups. 
      Randomized comparisons of these agents are needed to confirm these findings.
FAU - Wayangankar, Siddharth A
AU  - Wayangankar SA
AD  - University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. 
      siddharth-wayangankar@ouhsc.edu
FAU - Abu-Fadel, Mazen S
AU  - Abu-Fadel MS
FAU - Aronow, Herbert D
AU  - Aronow HD
FAU - Kennedy, Kevin F
AU  - Kennedy KF
FAU - Gupta, Raghav
AU  - Gupta R
FAU - Yeh, Robert W
AU  - Yeh RW
FAU - Gray, William A
AU  - Gray WA
FAU - Rosenfield, Kenneth
AU  - Rosenfield K
FAU - Hennebry, Thomas A
AU  - Hennebry TA
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20130326
PL  - United States
TA  - Circ Cardiovasc Interv
JT  - Circulation. Cardiovascular interventions
JID - 101499602
RN  - 0 (Anticoagulants)
RN  - 0 (Antithrombins)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Recombinant Proteins)
RN  - 9005-49-6 (Heparin)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
CIN - Circ Cardiovasc Interv. 2013 Apr;6(2):125-7. PMID: 23591418
MH  - Aged
MH  - Aged, 80 and over
MH  - Angioplasty/*adverse effects/mortality
MH  - Anticoagulants/administration & dosage/adverse effects
MH  - Antithrombins/administration & dosage/adverse effects
MH  - Brain Ischemia/mortality/*prevention & control
MH  - Carotid Stenosis/mortality/therapy
MH  - Female
MH  - Hemorrhage/*chemically induced/mortality
MH  - Heparin/administration & dosage/*adverse effects
MH  - Hirudins/administration & dosage/*adverse effects
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Myocardial Infarction/mortality
MH  - Peptide Fragments/administration & dosage/*adverse effects
MH  - Recombinant Proteins/administration & dosage/adverse effects
MH  - Registries/statistics & numerical data
MH  - Risk Factors
MH  - Stents/*adverse effects/statistics & numerical data
MH  - Stroke/mortality
EDAT- 2013/03/28 06:00
MHDA- 2013/10/29 06:00
CRDT- 2013/03/28 06:00
PHST- 2013/03/28 06:00 [entrez]
PHST- 2013/03/28 06:00 [pubmed]
PHST- 2013/10/29 06:00 [medline]
AID - CIRCINTERVENTIONS.112.974857 [pii]
AID - 10.1161/CIRCINTERVENTIONS.112.974857 [doi]
PST - ppublish
SO  - Circ Cardiovasc Interv. 2013 Apr;6(2):131-8. doi: 
      10.1161/CIRCINTERVENTIONS.112.974857. Epub 2013 Mar 26.