Subarachnoid Hemorrhage, Aneurysmal Clinical Trial
Official title:
Anticoagulant Efficacy and Safety of BivalirUdin Versus heparIn During coiL Embolization in Patients With ruptureD Intracranial Aneurysms: an Open-label, Multicenter, Randomized Pilot Study(BUILD)
This is a randomized, open label, multi-center, positive-controlled study, in which a total
of 236 patients will be enrolled and randomly assigned to receive bivalirudin or heparin in a
1:1 ratio during coil embolization in patients with ruptured intracranial aneurysms.
Procedure-related complication, mRS, Activated Clotting Time, ischemic and hemorrhagic
complications, symptomatic and asymptomatic intracranial hemorrhage, death, Heparin Induced
Thrombocytopenia will be evaluated during procedure, at 24hs, 7days and 30 days after.
Endovascular embolization has become an effective modality for the treatment of intracranial
aneurysms. Despite advances in technology and techniques, thromboembolic and bleeding events
are still encountered as inherent perioperative complications. Hypercoagulability as a
systemic response to acute subarachnoid hemorrhage (SAH) may be associated with an increased
incidence of thromboembolic events.
The administration of anticoagulant may reduce thromboembolic events during the endovascular
embolization, meanwhile, involves the risk of bleeding. Although heparin is commonly used
during the procedure, the safety in patients with ruptured intracranial aneurysms has not
been established. In contrast to heparin, bivalirudin is a short-lived direct thrombin
inhibitor with an intrinsic antiplatelet activity and more stable pharmacokinetic and
pharmacodynamic properties which has been associated with reduced bleeding and an overall
favorable profile. Bivalirudin administration in patients with high bleeding risk during
coronary intervention is recommended by current guidelines.
This is an open label, multicenter, randomized pilot study, which is aimed to investigate the
safety and efficacy of bivalirudin coil embolization in patients with ruptured intracranial
aneurysms.
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