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Adjunct bivalirudin dosing protocol for neuro-endovascular procedures

Alexandros L Georgiadis1, Qaisar Shah, M Fareed K Suri

  • 1Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota.

Journal of Vascular and Interventional Neurology
|April 21, 2012
PubMed

Insights

This study introduces a new bivalirudin dosing protocol for neuro-endovascular procedures. The proposed protocol aims for safe and effective anticoagulation by maintaining activated clotting time (ACT) within the target range.

Area of Science:

  • Neurology
  • Cardiology
  • Pharmacology

Background:

  • Anticoagulation is crucial in neuro-endovascular procedures.
  • Bivalirudin is a direct thrombin inhibitor with potential applications in this field.

Purpose of the Study:

  • To propose and evaluate a novel bivalirudin dosing protocol for neuro-endovascular procedures.
  • To assess the safety and efficacy of bivalirudin anticoagulation in this patient population.

Main Methods:

  • Three distinct bivalirudin dosing regimens were tested in four patients.
  • Activated clotting time (ACT) was continuously monitored.
  • The target ACT range was set between 300-350 seconds.

Main Results:

  • The initial protocols resulted in suboptimal ACT levels, either too high or too low.
  • The third protocol demonstrated improved outcomes, with ACT within the therapeutic range for 72% of the monitoring time.
  • ACT values did not exceed 366 seconds with the optimized protocol.

Conclusions:

  • Bivalirudin dosing requires specific adjustments for neuro-endovascular interventions.
  • A refined protocol shows promise for safe and effective anticoagulation.
  • Further research is necessary to validate the long-term safety and efficacy of bivalirudin in these procedures.
Abstract

Keywords:
anticoagulationbivalirudincarotid angioplastyintracranial angioplasty

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