Review of the use of parenteral direct thrombin inhibitors in carotid endarterectomy in patients with a history of heparin-induced thrombocytopenia
Bibliographic record
Abstract
IntroductionCarotid endarterectomy reduces the risk of recurrent stroke in symptomatic carotid stenosis. In patients with a history of heparin-induced thrombocytopenia, heparin is contraindicated, and these patients require an alternative parenteral anticoagulant during carotid endarterectomy. The aim of this review was to review the literature for evidence of the use of parenteral direct thrombin inhibitors (DTIs) (hirudin, hirudin derivates (lepirudin, desirudin, and bivalirudin), and argatroban) in carotid endarterectomy.MethodsA literature search was conducted using MEDLINE through PubMed on October 14, 2023. All reports which described treatment with parenteral direct thrombin inhibitors in carotid endarterectomy were included. Two authors independently screened abstract and titles according to the predefined criteria and nonagreement was discussed with a third author for the final decision.Results46 publications were identified, and 39 were excluded based on predefined criteria. Seven case reports were included, identifying seven patients who underwent carotid endarterectomy with intra-operative parenteral DTI use. There were four reports of use of argatroban, two of bivalirudin, and one report of hirudin in a case of concurrent carotid endarterectomy and coronary artery bypass grafting. Argatroban was the preferred agent in patients with renal insufficiency. DTIs were administered parenterally through bolus and infusion, and were monitored through activated clotting times (ACT) or plasma-modified ACT. There were no significant bleeding events, and all procedures were successfully performed. The pharmacology of DTIs and the use of DTIs in other peripheral vascular and cardiac procedures will also be reviewed.ConclusionOverall, the use of DTIs for anticoagulation in vascular surgery appears to be safe and effective. The DTIs with the most evidence supporting their use in carotid endarterectomy are bivalirudin and argatroban.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.009 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.011 | 0.014 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".