Safety and Efficacy of Bivalirudin as a Heparin Alternative in Patients Undergoing Carotid Artery Stenting
Observational / propensity-matched published in Ann Vasc Surg (2025)
Abstract
BACKGROUND: Transfemoral carotid artery stenting (TFCAS) and transcarotid artery revascularization (TCAR) are commonly used to treat carotid stenosis. However, the need for heparin alternatives during these procedures and their impact on outcomes remain unclear. This study evaluates the safety and efficacy of bivalirudin, the most commonly used heparin alternative, compared to heparin. METHODS: The Vascular Quality Initiative registry was queried for carotid artery stenting procedures performed from 2010 to 2022. Propensity-matched analyses compared outcomes between patients receiving intraprocedural heparin and those receiving bivalirudin. Primary outcomes were postoperative neurological events, including stroke or transient ischemic attack, and bleeding. Secondary outcomes included 30-day rates of reintervention and myocardial infarction, and mortality at 30 days and 1 year. RESULTS: Among 80,172 carotid artery stenting procedures, 2,789 (3.47%) were performed with bivalirudin. In the heparin group, 24,797 (34.1%) underwent TFCAS with distal embolic protection, while 47,961 (65.9%) underwent TCAR with flow reversal. In the bivalirudin group, 2,494 (91.2%) underwent TFCAS, and 240 (8.8%) underwent TCAR. Propensity matching created 2 cohorts of 957 patients each. There were no significant differences in neurological events (odds ratio, [OR]: 1.44, 95% confidence interval [CI]: 0.72-2.86; P = 0.30), bleeding (OR: 1.0, 95% CI: 0.53-1.90; P = 1.00), 30-day mortality (OR: 2.05, 95% CI: 0.62-6.85; P = 0.24), or 1-year mortality (OR: 1.37, 95% CI: 0.84-2.24; P = 0.21). CONCLUSION: Bivalirudin is a safe and effective alternative to heparin for patients with contraindications to heparin undergoing carotid artery stenting. These findings suggest no significant differences in outcomes, supporting bivalirudin as a viable anticoagulation option.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Zusammenfassung
Propensity-matched analysis from the Vascular Quality Initiative registry (80,172 procedures, 2,789 with bivalirudin) showing no significant differences in neurological events, bleeding, or mortality between bivalirudin and heparin during carotid stenting.
Warum dies für die Hirudotherapie relevant ist
Diese retrospektive Registerstudie evaluierte Bivalirudin – einen direkten Thrombininhibitor, der strukturell von Hirudin abgeleitet ist, dem Signatur-Antikoagulans des Sekretoms des medizinischen Blutegels – als Alternative zu Heparin während der Karotisarterien-Stentimplantation. Unter 80.172 Eingriffen zeigten propensity-gematchte Kohorten von jeweils 957 Patienten keine signifikanten Unterschiede bei postoperativen neurologischen Ereignissen (Schlaganfall/TIA), Blutungen oder Mortalität nach 30 Tagen oder 1 Jahr. Für die Hirudotherapie und ASH bieten diese Ergebnisse eine bedeutsame klinische Validierung, dass eine aus Blutegeln abgeleitete Antikoagulanzien-Klasse in einem wichtigen endovaskulären Setting vergleichbar wie Heparin abschneidet, was die translationale Relevanz des Blutegel-Sekretoms über die traditionellen topischen Blutegelanwendungen hinaus unterstreicht. Eine wichtige Einschränkung besteht darin, dass das Design des Beobachtungsregisters trotz Propensity-Matching einen Selektionsbias nicht vollständig eliminieren kann und Bivalirudin-Empfänger überwiegend transfemoralen statt transkarotidealen Zugangswegen unterzogen wurden, was die Generalisierbarkeit über prozedurale Kontexte einschränken kann.
Zitation
Safety and Efficacy of Bivalirudin as a Heparin Alternative in Patients Undergoing Carotid Artery Stenting.
Kania TA et al. · Annals of vascular surgery, 2025
Verwandter klinischer Kontext
Erfahren Sie, wie diese Forschung mit der klinischen Praxis verknüpft ist
Zur ASH-Bibliothek hinzugefügt: May 27, 2026 · Letzte Aktualisierung der Website: 18. Juni 2026