Antiplatelet and anticoagulant therapy in carotid endarterectomies

Česká verzia

Authors: M. Orlický ^1,2; P. Vachata ¹; P. Waldauf ³ ; M. Sameš ¹
Authors place of work: 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 the journal: Cesk Slov Neurol N 2018; 81(4): 444-449
Category: Original Paper
doi: https://doi.org/10.14735/amcsnn2018444

Summary

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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