Chronic oral anticoagulant therapy in carotid artery stenting: the un-necessity of perioperative bridging heparin therapy

Introduction: Chronic oral anticoagulant therapy (OAT) is of widespread use, and usually its management in patients undergoing carotid artery stenting (CAS) is through perioperative bridging heparin therapy. Aim of the present study is to analyze a single center experience of CAS in patients maintaining OAT without perioperative bridging heparin therapy.

Materials and methods: A retrospective evaluation of consecutive patients submitted to CAS was performed. Clinical anatomical characteristics and chronic OAT were evaluated to find a correlation with stroke, death, myocardial infarction and bleeding from the access site by Chi-square, Fisher's tests and regression analysis.

Results: 502 CAS were performed in a 5-year period. Twelve (2.4%) strokes, 1 (0.2%) death, no myocardial infarctions and 4 (0.8%) access site bleeding occurred in the perioperative period. In the overall population the presence of type 3 or bovine aortic arch was associated with stroke (5.5% vs. 1.5% p=0.02), and preoperative neurological ischemic symptoms were correlated with higher incidence of the composite event of stroke/death (4.8% vs. 1.4%, p=0.05). Twenty patients (4.0%) under chronic OAT were submitted to CAS without perioperative bridging heparin therapy with no complications. Overall, patients under OAT had no significantly different outcome compared with patients without OAT.

Conclusions: OAT without perioperative bridging heparin therapy is safe and effective. This data could be useful in the management of patients with chronic OAT submitted to CAS.