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New Anticoagulant Shows Promise for Carotid Artery Stenting

Results similar to unfractionated heparin

Bivalirudin is a safe and effective alternative anticoagulation strategy for carotid artery stenting (CAS), according to a recent study published in the Journal of Interventional Cardiology.

Although unfractionated heparin is the most commonly used anticoagulant in vascular and endovascular procedures, there are several clinically relevant drawbacks. These include a narrow therapeutic window requiring continuous monitoring and the possibility of thrombocytopenia. Bleeding complications are often the result of these drawbacks. Some prior research showed more predictable dose-response patterns and a shorter plasma half-life with the newer anticoagulant bivalirudin, but little data existed in CAS. The authors of the current study therefore sought to investigate. They tracked 272 patients treated with extracranial CAS between January 2001 and November 2010 at their Miami hospital. Median age was 72 years.

Participants in the study were stratified based on whether unfractionated heparin or bivalirudin was used during CAS. Clopidogrel and aspirin (325 and 75 mg, respectively) were given both before and after the procedure. Aspirin was continued for life, and clopidogrel for at least three months. Twelve patients -- 4.4 percent -- died or experienced stroke or myocardial infarction, and there were no significant differences between the groups. Bleeding complications were also similar. The authors write that the greater cost of bivalirudin will need to be balanced with the clinical benefit. “Bivalirudin [is] an interesting alternative for clinicians” and is “therapeutic,” they conclude.

Source: Katzen BT, Pena C, Benenati JF, et al. 2011. Bivalirudin used as alternative anticoagulant in carotid artery stenting: a single center observational study. Published on October 9, 2011 on the Journal of Interventional Cardiology website.