PMID- 28045242
OWN - NLM
STAT- MEDLINE
DCOM- 20170320
LR  - 20170320
IS  - 1827-191X (Electronic)
IS  - 0021-9509 (Linking)
VI  - 58
IP  - 2
DP  - 2017 Apr
TI  - Evidence for periprocedural antiplatelet therapy, heparinization and bridging of 
      coumarin therapy in carotid revascularization.
PG  - 143-151
LID - 10.23736/S0021-9509.16.09851-7 [doi]
AB  - Thromboembolism prevention is a crucial factor determining both the natural 
      outcome and outcome of intervention of stenotic atherosclerotic carotid artery 
      pathology. Roughly 80% of all natural course cerebral ischemic events are caused 
      by thromboembolism, versus 20% due to hemodynamic insufficiency. The risk of 
      periprocedural cerebral (micro-) thromboembolization during carotid 
      revascularization is considered to be even higher, with a higher rate in carotid 
      artery stenting (CAS) as compared to carotid endarterectomy (CEA). Guidelines on 
      CEA and CAS are unanimous in advising perioperative continuation of antiplatelet 
      therapy (APT) for all patients to prevent thromboembolization without 
      specification of the type of APT. Recommendations on dual antiplatelet (DAPT) 
      therapy are inconsistent. Bridging vitamin K antagonists (VKA) perioperative with 
      unfractionated heparin (UFH) or low-molecular weight heparins (LMWHs) might not 
      be necessary for CAS, while CEA-specific data is lacking. No data are available 
      on the use and position of direct-acting oral anticoagulants (DOACs) for CEA or 
      CAS. Guidelines on treatment of carotid artery disease currently do not provide 
      information on perioperative heparinization. There are several monitoring tools 
      to detect perioperative micro-embolic signals during intervention or new cerebral 
      white matter lesions following CEA or CAS. Transcranial Doppler ultrasonography 
      (TDU) and diffusion weighed imaging (DWI) might be used to assess these 
      (secondary) outcome measurements. The use of platelet function testing (PFT) to 
      tailor APT might contribute to finding the therapeutic place of stronger APT and 
      new APT regimen. Periprocedural antiplatelet and anticoagulation therapy for 
      carotid revascularization still lacks solid evidence and guidelines do not yet 
      cover the full spectrum of anticoagulants and procedural steps. This review aims 
      to cover and discuss the full spectrum of available antiplatelet and 
      anticoagulant drugs and therapies available for thromboembolism prevention during 
      all crucial steps of revascularization and specify the need to know topics to be 
      addressed in future research.
FAU - Brand, Aarent R
AU  - Brand AR
AD  - Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The 
      Netherlands.
FAU - de Borst, Gert J
AU  - de Borst GJ
AD  - Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The 
      Netherlands - g.j.deborst-2@umcutrecht.nl.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20170103
PL  - Italy
TA  - J Cardiovasc Surg (Torino)
JT  - The Journal of cardiovascular surgery
JID - 0066127
RN  - 0 (Anticoagulants)
RN  - 0 (Coumarins)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 9005-49-6 (Heparin)
RN  - A4VZ22K1WT (coumarin)
SB  - IM
MH  - *Angioplasty/adverse effects/instrumentation/mortality
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - Carotid Stenosis/blood/complications/diagnosis/*therapy
MH  - Coumarins/*administration & dosage/adverse effects
MH  - *Endarterectomy, Carotid/adverse effects/mortality
MH  - Heparin/*administration & dosage/adverse effects
MH  - Humans
MH  - Intracranial Embolism/blood/diagnosis/etiology/*prevention & control
MH  - Patient Selection
MH  - Platelet Aggregation Inhibitors/*administration & dosage/adverse effects
MH  - Risk Assessment
MH  - Risk Factors
MH  - Stents
MH  - Thromboembolism/blood/diagnosis/etiology/*prevention & control
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2017/01/04 06:00
MHDA- 2017/03/21 06:00
CRDT- 2017/01/04 06:00
PHST- 2017/01/04 06:00 [pubmed]
PHST- 2017/03/21 06:00 [medline]
PHST- 2017/01/04 06:00 [entrez]
AID - S0021-9509.16.09851-7 [pii]
AID - 10.23736/S0021-9509.16.09851-7 [doi]
PST - ppublish
SO  - J Cardiovasc Surg (Torino). 2017 Apr;58(2):143-151. doi: 
      10.23736/S0021-9509.16.09851-7. Epub 2017 Jan 3.