Introduction: Appropriate dosing of anticoagulation during carotid angioplasty and stenting remains unstudied. Although 70 units /kg is a commonly used dose, in patients with acute stroke, this dose may increase the risk of hemorrhagic transformation. We report safety of a novel low fixed-dose protocol in patients treated with CAS after recent ischemic event.
Methods: All patients who underwent carotid angioplasty and stenting after or during a recent admission with acute ischemic stroke, at a tertiary care hospital, from Jun 2012 to August 2015 were retrospectively identified from a prospectively maintained database. A dose of 25 u/kg was used if patient had a recent infarct on imaging, or in case imaging cannot rule out an acute infarct, a recent clinical stroke. In other patients a dose of 50 u/kg was used. Activated clotting time (ACT) was checked in all patients at the time of stent deployment.
Results: CAS was performed in 59 patients (mean age 71.3+/-13.3, 68% men) as per fixed-dose heparin protocol. Procedure was performed within 48 hours, 48 hours to 7 days, and after 7 days of the event in 18, 15 and 26 patients, respectively. Clinical characteristics of patients in three groups are shown in table. Only 2 patients suffered transient ischemic event and 1 patient suffered minor stroke during hospitalization. No patients suffered any hemorrhagic complication or death.
Conclusion: A fixed low dose heparin protocol during carotid angioplasty and stenting ay be safe and effective, especially in patients with recent ischemic stroke.