Evidence for periprocedural antiplatelet therapy, heparinization and bridging of coumarin therapy in carotid revascularization.

Evidence for periprocedural antiplatelet therapy, heparinization and bridging of coumarin therapy in carotid revascularization. J Cardiovasc Surg (Torino). 2017 Jan 03;: Authors: Brand A, DE Borst GJ Abstract Thromboembolism prevention is a crucial factor determining both the natural outcome and outcome of intervention of stenotic atherosclerotic carotid artery pathology. Roughly 80% of all natural course cerebral ischemic events are caused by thromboembolism, versus 20% due to hemodynamic insufficiency. The risk of periprocedural cerebral (micro) thromboembolization during carotid revascularization is considered to be even higher, with a higher rate in carotid artery stenting (CAS) as compared to carotid endarterectomy (CEA). Guidelines on CEA and CAS are unanimous in advizing perioperative continuation of antiplatelet therapy (APT) for all patients to prevent thromboembolization without specification of the type of APT. Recommendations on dual antiplatelet (DAPT) therapy are inconsistent. Bridging vitamin K antagonists (VKA) perioperative with unfractionated heparin (UFH) or low-molecular weight heparins (LMWHs) might not be necessary for CAS, while CEA-specific data is lacking. No data are available on the use and position of direct- acting oral anticoagulants (DOACs) for CEA or CAS. Guidelines on treatment of carotid artery disease currently do not provide information on peroperative heparinization. There are several monitoring t...
Source: The Journal of Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: J Cardiovasc Surg (Torino) Source Type: research