title: Carotid revascularization in patients with ongoing oral anticoagulant therapy: the advantages of stent placement.
abstract: OBJECTIVE
  To assess the influence of oral anticoagulant therapy conversion to heparin (OAT-CH) on carotid endarterectomy (CEA) outcomes and the influence of unmodified oral anticoagulant therapy (OAT) on carotid artery stenting (CAS) and to compare the outcomes of CEA in OAT-CH with CAS in ongoing OAT.
  
  
  METHODS
  The 30-day results from all patients who underwent CEA and CAS in a 6-year period were analyzed for stroke, death, myocardial infarction (MI), and hematoma of the access site requiring surgical evacuation. We evaluated the influence of OAT-CH in CEA and the influence of OAT in CAS and compared CEA and CAS outcomes in patients receiving OAT-CH and OAT.
  
  
  RESULTS
  Among 1,222 carotid revascularizations, there were 711 CEAs (58.1%) and 511 CAS procedures (41.9%). In the CEA group, 31 (4.4%) patients were treated with OAT-CH, and these patients had a significantly higher complication rate compared with patients not receiving OAT, including death (1 [3.2%] vs 4 [0.6%]; P = .04), stroke (4 [12.9%] vs 10 [1.4%]; P = .001), and hematoma (3 [9.6%] vs 11 [1.6%]; P = .02). In CAS, the results were similar in patients receiving OAT (30 [5.8%]) and patients not receiving OAT. Patients receiving OAT who underwent CAS had better outcomes than patients receiving OAT-CH who underwent CEA, including stroke, death, MI, and hematoma combined (0 [0.0%] vs 7 [22.5%]; P =.01).
  
  
  CONCLUSIONS
  OAT management significantly influences the results of carotid revascularization. Because CAS with unmodified OAT had a significantly better outcome than CEA with OAT-CH, carotid revascularization strategies should favor CAS rather than CEA in this setting.
authors: Department of Vascular Surgery, University of Bologna, Via Massarenti 11, Bologna 40138, Italy.
authors: Gianluca
authors: G
authors: Faggioli
authors: Rodolfo
authors: R
authors: Pini
authors: Claudio
authors: C
authors: Rapezzi
authors: Raffaella
authors: R
authors: Mauro
authors: Antonio
authors: A
authors: Freyrie
authors: Mauro
authors: M
authors: Gargiulo
authors: Letizia
authors: L
authors: Bacchi Reggiani
authors: Andrea
authors: A
authors: Stella
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D002340:Carotid Artery Diseases / Q000188:drug therapy / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016009:Chi-Square Distribution; D004334:Drug Administration Schedule; D057915:Drug Substitution; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006406:Hematoma / Q000209:etiology; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D006493:Heparin