OBJECTIVE: To introduce a protocol for anticoagulation using bivalirudin in neuro-endovascular procedures. METHODS: Three different bivalirudin dosing protocols were used in four consecutive patients undergoing neuro-endovascular procedures. Activated clotting time (ACT) was closely monitored to assess the effect of bivalirudin on ACT. Target ACT was set at 300-350 seconds. RESULTS: The first dosing protocol led to largely supra-therapeutic ACT values. With the second protocol, ACT remained sub-therapeutic for 25 minutes (33% of monitoring time). The third protocol was applied to two patients and it showed the best results with the ACT being in the therapeutic range for 72% of the combined monitoring time and never exceeding 366 seconds. CONCLUSIONS: The dosing of bivalirudin needs to be adjusted for the use in neuro-endovascular procedures. We are proposing a protocol that seems to provide safe and effective anticoagulation. The safety and efficacy of bivalirudin in neuroendovascular procedures will need to be further validated in future studies.
OBJECTIVE: To introduce a protocol for anticoagulation using bivalirudin in neuro-endovascular procedures. METHODS: Three different bivalirudin dosing protocols were used in four consecutive patients undergoing neuro-endovascular procedures. Activated clotting time (ACT) was closely monitored to assess the effect of bivalirudin on ACT. Target ACT was set at 300-350 seconds. RESULTS: The first dosing protocol led to largely supra-therapeutic ACT values. With the second protocol, ACT remained sub-therapeutic for 25 minutes (33% of monitoring time). The third protocol was applied to two patients and it showed the best results with the ACT being in the therapeutic range for 72% of the combined monitoring time and never exceeding 366 seconds. CONCLUSIONS: The dosing of bivalirudin needs to be adjusted for the use in neuro-endovascular procedures. We are proposing a protocol that seems to provide safe and effective anticoagulation. The safety and efficacy of bivalirudin in neuroendovascular procedures will need to be further validated in future studies.
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Authors: A Michael Lincoff; John A Bittl; Robert A Harrington; Frederick Feit; Neal S Kleiman; J Daniel Jackman; Ian J Sarembock; David J Cohen; Douglas Spriggs; Ramin Ebrahimi; Gadi Keren; Jeffrey Carr; Eric A Cohen; Amadeo Betriu; Walter Desmet; Dean J Kereiakes; Wolfgang Rutsch; Robert G Wilcox; Pim J de Feyter; Alec Vahanian; Eric J Topol Journal: JAMA Date: 2003-02-19 Impact factor: 56.272
Authors: David J Cohen; A Michael Lincoff; Tara A Lavelle; Huei-Ling Chen; Ameet Bakhai; Ronna H Berezin; Daniel Jackman; Ian J Sarembock; Eric J Topol Journal: J Am Coll Cardiol Date: 2004-11-02 Impact factor: 24.094
Authors: J A Bittl; J Strony; J A Brinker; W H Ahmed; C R Meckel; B R Chaitman; J Maraganore; E Deutsch; B Adelman Journal: N Engl J Med Date: 1995-09-21 Impact factor: 91.245
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