title: Bivalirudin used as alternative anticoagulant in carotid artery stenting: a single center observational study.
abstract: OBJECTIVE
  To analyze and report the safety and effectiveness of bivalirudin in a large patient population undergoing carotid artery stenting (CAS).
  
  
  METHODS
  Between January 2001 and November 2010 extracranial CAS was performed in 272 patients in our institution. These patients were stratified according to the anticoagulant used during the CAS procedure into 2 groups (bivalirudin n = 217 vs. unfractionated heparin [UFH] n = 55) and analyzed regarding bleeding complications and periprocedural (within 30 days) stroke and myocardial infarction (MI) rates.
  
  
  RESULTS
  The combined end-point of death, stroke, and MI occurred in 12 patients (4.4%) with no significant difference between the groups (bivalirudin 4.6% vs. UFH 3.6% P value 0.96). Stroke rates were 1.8% in the bivalirudin and 1.8% in the UFH group (P value 1.00), with 4/5 strokes being nondisabling. Periprocedural MI was observed in 7 patients (2.1%) with no significant differences between the groups (bivalirudin 2.7% vs. UFH 1.8%, P value 0.94). Bleeding complications occurred in 13/272 patients (4.7%) with no significant difference between the groups (bivalirudin 3.6% vs. UFH 9.0%, P value 0.15). The first activated clotting time after administration of the anticoagulants was therapeutic in 209/217 (96%) in the bivalirudin group and in 30/55 (55%) in the UFH group (P < 0.001).
  
  
  CONCLUSIONS
  In this single-center study, bivalirudin was a safe and efficient anticoagulation strategy for CAS and could be considered a therapeutic alternative to UFH.
authors: Baptist Cardiac and Vascular Institute, Division of Vascular and Interventional Radiology, Miami, Florida 33176, USA. philippgeisbuesch@gmx.de
authors: Philipp
authors: P
authors: Geisbüsch
authors: Barry T
authors: BT
authors: Katzen
authors: Constantino
authors: C
authors: Peña
authors: James F
authors: JF
authors: Benenati
authors: Heiko
authors: H
authors: Uthoff
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000991:Antithrombins / Q000627:therapeutic use*; D016893:Carotid Stenosis / Q000188:drug therapy*; D000077144:Clopidogrel; D005260:Female; D006629:Hirudins; D006801:Humans; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011994:Recombinant Proteins / Q000627:therapeutic use; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D010975:Platelet Aggregation Inhibitors; D011994:Recombinant Proteins; D000077144:Clopidogrel; D013988:Ticlopidine; C074619:bivalirudin