Courtesy of Dr. Carlos Fava

Bivalirudin has been shown to reduce bleeding in carotid stenting and maintain its efficacy. Even though carotid stenting has shown benefits, these remain unclear.

With this in mind, four studies were analyzed (one randomized) including 7,784 patients undergoing carotid stenting with unfractioned heparin vs. bivalirudin.

No difference was found between the groups across the different studies.

Bivalirudin was shown to reduce major bleeding rate with a relative risk (RR) of 0.53 (95% CI: 0.35-0.8; I²=0%) and minor bleeding RR of 0.41 (95% CI: 0.2-0.82; I² =0%), with no difference in ischemic stroke, intracranial bleeding, infraction or mortality at 30 days.

Conclusion

Compared to unfractioned heparin, bivalirudin was associated with lower bleeding risk when used in carotid stenting.

Comment

The use of bivalirudin has shown this benefit in coronary PCI, but the transradial approach has also shown this benefit in PCI with unfractioned heparin.

In addition, bivalirudin significantly increases costs compared to unfractioned heparin.

Perhaps the use of the transradial approach (which several studies show as feasible and safe) neutralizes this benefit of bivalirudin, except for those cases that, for several reasons, should be done via femoral.  

Courtesy of Dr. Carlos Fava

Original Title: Hemorrhagic and Ischemic Outcomes of Heparin vs. Bivalirudin in Carotid Artery Stenting: A Meta-analysis of Studies.

Reference: Jad Omran, et; al. Catheterization and Cardiovascular Intervention 2017;88:746-753.

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