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Kapur V. Antithrombotic Strategies in Endovascular Interventions. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Hu Y, Liu AY, Zhang L, Wu X, Shi S, Elmore JR, Zhang X. A systematic review and meta-analysis of bivalirudin application in peripheral endovascular procedures. J Vasc Surg 2019; 70:274-284.e5. [PMID: 31230646 DOI: 10.1016/j.jvs.2018.12.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 12/11/2018] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The direct thrombin inhibitor bivalirudin (BIV) was shown to be superior to unfractionated heparin (UFH) in percutaneous coronary interventions for reducing procedural blood loss. The aim of this study was to compare outcome profiles of BIV and UFH in peripheral endovascular procedures (PEPs) by synthesizing the currently available data. METHODS Following the PRISMA statement, we conducted a comprehensive literature search using Medline, Cochrane CENTRAL, PubMed, EMBASE, CINAHL Google scholar, and clinicaltrials.gov. We recruited randomized, controlled trials and well-conducted observational studies that compared UFH and BIV in PEPs requiring anticoagulation, excluding endovascular cardiac procedures and coronary interventions. Random-effects meta-analyses were conducted to compare the outcome profiles of these two agents. RESULTS Thirteen articles containing 14 studies involving a total of 21,057 patients were enrolled. Of these, 2 were randomized controlled trials, 2 were prospective cohort studies, and 10 were retrospective studies. There were no significant differences between BIV and UFH in terms of procedural success rates, major and minor perioperative bleeding, transfusion, perioperative transient ischemic attack, or hemorrhagic strokes. However, compared with UFH, BIV had significantly lower odds ratios (OR) of perioperative mortality (OR, 0.58; 95% confidence interval [CI], 0.40-0.86), major adverse cardiovascular events (OR, 0.65; 95% CI, 0.51-0.83), net adverse clinical events (OR, 0.75; 95% CI, 0.63-0.88), perioperative myocardial infarction (OR, 0.73; 95% CI, 0.55-0.98), major vascular complications (OR, 0.59; 95% CI, 0.39-0.91), and minor vascular complications (OR, 0.58; 95% CI, 0.40-0.84). CONCLUSIONS Compared with UFH, PEPs using BIV had comparable procedural success rates and odds of perioperative transient ischemic attack and hemorrhagic stroke. However, procedures with BIV had a lower but nonsignificant odds of perioperative bleeding and transfusion. Depending on the procedures conducted, the patients who received BIV will have reduced or comparable odds of perioperative mortality, myocardial infarction, major adverse cardiovascular events, net adverse clinical events, and major and minor vascular complications. Therefore, BIV may be chosen solely as an alternative procedural anticoagulant to UFH for PEPs.
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Affiliation(s)
- Yirui Hu
- Biomedical & Translational Informatics, Geisinger Medical Center, Danville, Penn
| | - Anastasia Yian Liu
- Department of Cell and Systems Biology, University of Toronto, Toronto, Ontario, Canada
| | - Li Zhang
- Division of Anesthesiology, Geisinger Medical Center, Danville, Penn
| | - Xianren Wu
- Division of Anesthesiology, Geisinger Medical Center, Danville, Penn
| | - Shuai Shi
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - James R Elmore
- Department of Vascular Surgery, Geisinger Medical Center, Danville, Penn
| | - Xiaopeng Zhang
- Division of Anesthesiology, Geisinger Medical Center, Danville, Penn.
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Liu H, Tu M, Cheng S, Chen H, Wang Z, Du M. An anticoagulant peptide from beta-casein: identification, structure and molecular mechanism. Food Funct 2019; 10:886-892. [DOI: 10.1039/c8fo02235f] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A bioactive peptide is identified from casein hydrolysates.
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Affiliation(s)
- Hanxiong Liu
- School of Food Science and Technology
- National Engineering Research Center of Seafood
- Dalian Polytechnic University
- Dalian 116034
- China
| | - Maolin Tu
- Department of Chemistry and Chemical Engineering
- Harbin Institute of Technology
- Harbin 150090
- China
| | - Shuzhen Cheng
- School of Food Science and Technology
- National Engineering Research Center of Seafood
- Dalian Polytechnic University
- Dalian 116034
- China
| | - Hui Chen
- School of Food Science and Technology
- National Engineering Research Center of Seafood
- Dalian Polytechnic University
- Dalian 116034
- China
| | - Zhenyu Wang
- School of Food Science and Technology
- National Engineering Research Center of Seafood
- Dalian Polytechnic University
- Dalian 116034
- China
| | - Ming Du
- School of Food Science and Technology
- National Engineering Research Center of Seafood
- Dalian Polytechnic University
- Dalian 116034
- China
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Olmedo W, Villablanca PA, Sanina C, Walker J, Weinreich M, Brevik J, Avendano R, Bravo CA, Romero J, Ramakrishna H, Babaev A, Attubato M, Hernandez-Suarez DF, Cox-Alomar P, Pyo R, Krishnan P, Wiley J. Bivalirudin versus heparin in patients undergoing percutaneous peripheral interventions: A systematic review and meta-analysis. Vascular 2018; 27:78-89. [DOI: 10.1177/1708538118807522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Bivalirudin may be an effective alternative anticoagulant to heparin for use in percutaneous peripheral interventions. We aimed to compare the safety and efficacy of bivalirudin versus heparin as the procedural anticoagulant agent in patients undergoing percutaneous peripheral intervention. Methods For this meta-analysis and systematic review, we conducted a search in PubMed, Medline, Embase, and Cochrane for all the clinical studies in which bivalirudin was compared to heparin as the procedural anticoagulant in percutaneous peripheral interventions. Outcomes studied included all-cause mortality, all-bleeding, major and minor bleeding, and access site complications. Results Eleven studies were included in the analysis, totaling 20,137 patients. There was a significant difference favoring bivalirudin over heparin for all-cause mortality (risk ratio 0.58, 95% CI 0.39–0.87), all-bleeding (risk ratio 0.62, 95% CI 0.50–0.78), major bleeding (risk ratio 0.61, 95% CI 0.39–0.96), minor bleeding (risk ratio 0.66, 95% CI 0.47–0.92), and access site complications (risk ratio 0.66, 95% CI 0.51–0.84). There was no significant difference in peri-procedural need for blood transfusions (risk ratio 0.79, 95% CI 0.57–1.08), myocardial infarction (risk ratio 0.87, 95% CI 0.59–1.28), stroke (risk ratio 0.77, 95% CI 0.59–1.01), intracranial bleeding (risk ratio 0.77, 95% CI 0.29–2.02), or amputations (OR 0.75, 95% CI 0.53–1.05). Conclusion Our meta-analysis suggests that bivalirudin use for percutaneous peripheral interventions is associated with lower all-cause mortality, bleeding, and access site complications as compared to heparin. Further large randomized trials are needed to confirm the current results.
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Affiliation(s)
- Wilman Olmedo
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Pedro A Villablanca
- Division of Cardiology, New York University School of Medicine, New York, NY, USA
| | - Cristina Sanina
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jonathan Walker
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michael Weinreich
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jeannine Brevik
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ricardo Avendano
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Claudio A Bravo
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jorge Romero
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic College of Medicine, Scottsdale, AZ, USA
| | - Anvar Babaev
- Division of Cardiology, New York University School of Medicine, New York, NY, USA
| | - Michael Attubato
- Division of Cardiology, New York University School of Medicine, New York, NY, USA
| | - DF Hernandez-Suarez
- Cardiology Section, Medicine Division, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - P Cox-Alomar
- Section of Cardiology, Division of Medicine, Louisiana State University School of Medicine, New Orleans, LA, USA
| | - Robert Pyo
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Prakash Krishnan
- Division of Cardiology, Mount Sinai Medical Center, New York, NY, USA
| | - Jose Wiley
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Comparison between activated clotting time and anti-activated factor X activity for the monitoring of unfractionated heparin therapy in patients with aortic aneurysm undergoing an endovascular procedure. J Vasc Surg 2018; 68:400-407. [DOI: 10.1016/j.jvs.2017.11.079] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/27/2017] [Indexed: 12/17/2022]
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Omran J, Enezate T, Abdullah O, Al-Dadah AS, Aronow HD, Mustapha J, Saab F, Brilakis ES, Reeves RR, Bhatt DL, Mahmud E. Bivalirudin versus unfractionated heparin in peripheral vascular interventions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:695-699. [PMID: 29477790 DOI: 10.1016/j.carrev.2018.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 01/15/2018] [Accepted: 01/19/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND A number of studies suggest that bivalirudin (BIV) is associated with similar efficacy but reduced bleeding when compared with unfractionated heparin (UFH) in patients undergoing peripheral vascular interventions (PVI). METHODS A comprehensive literature search was conducted with the electronic databases MEDLINE, EMBASE and CENTRAL. These were queried to identify studies comparing BIV with UFH in PVI. Study endpoints included total bleeding events, major and minor bleeding events and procedural success. Random-effects meta-analysis method was used to pool endpoint odds ratios (OR) for both UFH and BIV with 95% confidence intervals (CI). RESULTS A total of 12,335 patients (70.6 years; 59.7% male) were included from seven observational cohort studies (two prospective and five retrospective) comparing outcomes between BIV and UFH during PVI between January 2000 and May 2017. Compared with BIV, UFH was associated with significantly higher total bleeding, (OR 1.52 with 95% CI 1.11 to 2.09, p = 0.009), major bleeding (OR 1.38 with 95% CI 1.13 to 1.68, p = 0.002), and minor bleeding (OR 1.51 with 95% CI 1.09 to 2.08, p = 0.01). Procedural success rates were not different between the two groups (BIV vs HEP: OR 0.90 with 95% CI 0.49 to 1.64, p = 0.72) CONCLUSION: Compared with BIV, UFH was associated with more bleeding when used during PVI. There was no significant difference in procedural success between the two anticoagulation strategies.
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Affiliation(s)
- Jad Omran
- University of California San Diego, La Jolla, CA, USA
| | | | | | | | - Herbert D Aronow
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jihad Mustapha
- Metro Health System, University of Michigan Health, Wyoming, MI, USA
| | - Fadi Saab
- Metro Health System, University of Michigan Health, Wyoming, MI, USA
| | | | - Ryan R Reeves
- University of California San Diego, La Jolla, CA, USA
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA, USA
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Shishehbor MH. Antithrombotic Strategies in Endovascular Interventions. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Wiersema AM, Watts C, Durran AC, Reijnen MMPJ, van Delden OM, Moll FL, Vos JA. The Use of Heparin during Endovascular Peripheral Arterial Interventions: A Synopsis. SCIENTIFICA 2016; 2016:1456298. [PMID: 27190678 PMCID: PMC4852120 DOI: 10.1155/2016/1456298] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 03/09/2016] [Indexed: 06/05/2023]
Abstract
A large variety exists for many aspects of the use of heparin as periprocedural prophylactic antithrombotics (PPAT) during peripheral arterial interventions (PAI). This variation is present, not only within countries, but also between them. Due to a lack of (robust) data, no systematic review on the use of heparin during PAI could be justified. A synopsis of all available literature on heparin during PAI describes that heparin is used on technical equipment to reduce the thrombogenicity and in the flushing solution with saline. Heparin could have a cumulative anticoagulant effect when used in combination with ionic contrast medium. No level-1 evidence exists on the use of heparin. A measurement of actual anticoagulation status by means of an activated clotting time should be mandatory.
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Affiliation(s)
- Arno M. Wiersema
- Department of Surgery, Division of Vascular Surgery, Westfriesgasthuis, Maelsonstraat 3, 1624 NP Hoorn, Netherlands
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Utrecht, University of Utrecht, Postbus 85500, 3508 GA Utrecht, Netherlands
| | - Christopher Watts
- Department of Radiology, Salisbury District Hospital, Odstock Road, Salisbury, Wiltshire SP2 8BJ, UK
| | | | - Michel M. P. J. Reijnen
- Department of Surgery, Rijnstate Hospital, Arnhem, Postbus 9555, 6800 TA Arnhem, Netherlands
| | - Otto M. van Delden
- Department of Radiology, Division of Interventional Radiology, Academic Medical Centre, University of Amsterdam, Postbus 22660, 1100 DD Amsterdam, Netherlands
| | - Frans L. Moll
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Utrecht, University of Utrecht, Postbus 85500, 3508 GA Utrecht, Netherlands
| | - Jan Albert Vos
- Department of Radiology, Division of Interventional Radiology, St. Antonius Hospital, Postbus 2500, 3430 EM Nieuwegein, Netherlands
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Donovan RJ, Ha J, Sumption KF, Dardik A, Jovin IS. Adjunctive anticoagulation during peripheral vascular intervention. Am Heart J 2016; 172:106-14. [PMID: 26856222 DOI: 10.1016/j.ahj.2015.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 11/14/2015] [Indexed: 11/18/2022]
Abstract
Endovascular techniques for the treatment of peripheral arterial disease are becoming an increasingly common alternative to open surgery, yet the degree of anticoagulation and choice of anticoagulant to optimize outcomes in these procedures remain uncertain. To date, few randomized trials have directly compared different anticoagulants for use during peripheral vascular interventions. It is also unclear if the approach to anticoagulation should be individualized to each vascular bed or if common principles are shared among them. This has led practitioners across different specialties to use a variety of different methods for anticoagulation, with most extrapolated from techniques used in percutaneous coronary interventions. In this review, we analyze the current literature for anticoagulation used during peripheral vascular intervention of the lower extremity, renal, carotid, and aortic arteries, with special consideration to the choice of anticoagulant used to maximize safe and effective procedural outcomes.
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Affiliation(s)
- Robert J Donovan
- Department of Medicine, Medical College of Virginia of Virginia Commonwealth University and McGuire VAMC, Richmond, VA
| | - Jonathan Ha
- Department of Radiology, Medical College of Virginia of Virginia Commonwealth University and McGuire VAMC, Richmond, VA
| | - Kevin F Sumption
- Department of Medicine, Medical College of Virginia of Virginia Commonwealth University and McGuire VAMC, Richmond, VA
| | - Alan Dardik
- Department of Surgery, Yale School of Medicine, New Haven, CT and West Haven VAMC, West Haven, CT
| | - Ion S Jovin
- Department of Medicine, Medical College of Virginia of Virginia Commonwealth University and McGuire VAMC, Richmond, VA.
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Schernthaner MB, Samuels S, Biegler P, Benenati JF, Uthoff H. Ultrasound-Accelerated versus Standard Catheter-Directed Thrombolysis in 102 Patients with Acute and Subacute Limb Ischemia. J Vasc Interv Radiol 2014; 25:1149-56; quiz 1157. [DOI: 10.1016/j.jvir.2014.03.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 03/14/2014] [Accepted: 03/14/2014] [Indexed: 11/26/2022] Open
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Van De Car DA, Rao SV, Ohman EM. Bivalirudin: a review of the pharmacology and clinical application. Expert Rev Cardiovasc Ther 2014; 8:1673-81. [DOI: 10.1586/erc.10.158] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Shishehbor MH, Katzen BT. Antithrombotic Strategies in Endovascular Interventions: Current Status and Future Directions. Interv Cardiol Clin 2013; 2:627-633. [PMID: 28582189 DOI: 10.1016/j.iccl.2013.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Despite increasing numbers of endovascular interventions to treat arterial and venous disease, scant level 1 evidence is available regarding the role of antithrombotic and antiplatelet therapy in patients undergoing these procedures. The current practice in this regard is heterogeneous and has mainly been driven by data from coronary artery disease and percutaneous coronary intervention. This article discusses the role of antithrombotic and antiplatelet agents for endovascular intervention.
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Affiliation(s)
- Mehdi H Shishehbor
- Endovascular Services, Heart & Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J3-05, Cleveland, OH 44195, USA.
| | - Barry T Katzen
- Baptist Cardiac & Vascular Institute, 8900 North Kendall Drive, Miami, FL 33176, USA
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Periprocedural Prophylactic Antithrombotic Strategies in Interventional Radiology: Current Practice in the Netherlands and Comparison with the United Kingdom. Cardiovasc Intervent Radiol 2013; 36:1477-1492. [DOI: 10.1007/s00270-013-0558-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Accepted: 12/18/2012] [Indexed: 10/27/2022]
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Baker R, Samuels S, Benenati JF, Powell A, Uthoff H. Ultrasound-accelerated vs Standard Catheter-directed Thrombolysis—A Comparative Study in Patients with Iliofemoral Deep Vein Thrombosis. J Vasc Interv Radiol 2012; 23:1460-6. [DOI: 10.1016/j.jvir.2012.08.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 08/03/2012] [Accepted: 08/09/2012] [Indexed: 12/01/2022] Open
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Prophylactic Perioperative Anti-Thrombotics in Open and Endovascular Abdominal Aortic Aneurysm (AAA) Surgery: A Systematic Review. Eur J Vasc Endovasc Surg 2012; 44:359-67. [DOI: 10.1016/j.ejvs.2012.06.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 06/13/2012] [Indexed: 11/20/2022]
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GEISBÜSCH PHILIPP, KATZEN BARRYT, PEÑA CONSTANTINO, BENENATI JAMESF, UTHOFF HEIKO. Bivalirudin Used as Alternative Anticoagulant in Carotid Artery Stenting: A Single Center Observational Study. J Interv Cardiol 2011; 25:197-202. [DOI: 10.1111/j.1540-8183.2011.00684.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Anand SX, Viles-Gonzalez JF, Mahboobi SK, Heerdt PM. Bivalirudin utilization in cardiac surgery: shifting anticoagulation from indirect to direct thrombin inhibition. Can J Anaesth 2010; 58:296-311. [DOI: 10.1007/s12630-010-9423-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 11/03/2010] [Indexed: 01/19/2023] Open
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