Seguridad y eficacia de la bivalirudina como alternativa a la heparina en pacientes sometidos a stent carotídeo

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.

Resumen tomado de PubMed (NCBI) para el registro citado, en el idioma original. La versión de referencia es la de la publicación original.

El resumen se deja sin traducir para conservar la redacción original de los autores.

Se analizaron 80 172 procedimientos de stent carotídeo del registro Vascular Quality Initiative (2010-2022); 2 789 (3,47 %) con bivalirudina. En cohortes emparejadas de 957 pacientes no hubo diferencias significativas frente a la heparina en eventos neurológicos (OR 1,44; IC 95 % 0,72-2,86; p = 0,30), hemorragias (OR 1,0), mortalidad a 30 días (OR 2,05) ni a 1 año (OR 1,37). Los autores concluyen que la bivalirudina es una alternativa segura y eficaz en pacientes con contraindicación a la heparina.

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