Antiplatelet and anticoagulant ther­apy in carotid endarterectomies


Authors: M. Orlický 1,2;  P. Vachata 1;  P. Waldauf 3;  M. Sameš 1
Authors‘ workplace: Neurochirugická klinika UJEP a Masarykova nemocnice, o. z., Krajská zdravotní, a. s., Ústí nad Labem 1;  Neurochirurgická klinika UNLP, Košice 2;  Klinika anesteziologie a resuscitace FN Královské Vinohrady, Praha 3
Published in: Cesk Slov Neurol N 2018; 81(4): 444-449
Category: Original Paper
doi: 10.14735/amcsnn2018444

Overview

Aim:
The influence of antiplatelet agents and anticoagulants on hemorrhagic complications and the development of ischaemic brain lesions during carotid endarterectomies (CEAs) was studied.

Methods:
During 559 CEAs antithrombotic ther­apy, as administrated by a refer­ral doctor, was kept. The influence of antithrombotic ther­apy on the: 1. incidence of wound hematoma; 2. incidence of symptomatic intracerebral hematoma after CEA; 3. length of hospital stay; 4. incidence of new brain ischaemic lesions were studied.

Results:
In total, wound hematoma was found in 43 (7.69%) cases. Of those there were: 1. 2.94% in „no antithrombotic“ group; 2. 5.18% (p = 0.55) in the acetylsalicylic acid (ASA)/ASA + derivates group; 3. 18.36% (p = 0.008) in clopidogrel group; 4. 0% in ticlopidin group; 5. 20% = 0.022) in low molecular weight heparin (LMWH) group; 6. 19.05% (p = 0.026) in LMWH + ASA group; 7. 36,36% (p = 0.003) in clopidogrel + ASA group. Incidence of symp­tomatic intracerebral hematoma after CEA was 0.89% in five cases. The mean length of hospital stay was 4.7 days for uncomplicated cases, 5.1 days for cases with hematoma without reoperation and 7.2 days for cases with hematoma with reoperation. Incidence of new ischaemic lesions after CEA was 10.91%, not related to antithrombotic ther­apy (p > 0.18).

Conclusion:
Clopidogrel, LMWH and LMWH + ASA groups showed app. 4 times higher risk of wound hematoma, dual antiplatelet ther­apy 5.5 times higher compared to ASA ther­apy only. Therefore, their use preoperatively in CEA should be restricted for cases of symp­tomatic stenosis with high recur­rent risk of stroke. No influence of antithrombotics on the incidence of new ischaemic brain lesions dur­­ing CEA was showed.

Key words:
antiplatelet therapy – anticoagulants – wound hematoma – ischaemic brain lesions – carotid endarterectomy

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.


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