Influence of antiplatelet therapy on cerebral micro-emboli after carotid endarterectomy using postoperative transcranial Doppler monitoring.
OBJECTIVE
To study the effect of different antiplatelet regimens (APT) on the rate of postoperative TCD registered micro-embolic signals (MES) following carotid endarterectomy (CEA).


METHODS
Prospective, randomised, double-blinded, pilot study.


METHODS
The study group of 102 CEA patients (76 men, mean age 66.8 years) was randomised to routine Asasantin (Dipyridamole 200mg/Aspirin 25mg) twice daily (group I; n=39), Asasantin plus 75 mg Clopidogrel once daily (group II; n=33), or Asasantin plus Rheomacrodex (Dextran 40) 100g/L iv; 500 ml (group III; n=30). TCD monitoring of the ipsilateral middle cerebral artery for the occurrence of MES was performed intra-operatively and during the second postoperative hour following CEA. Primary endpoints were the rate of postoperative emboli and the occurrence of cerebrovascular complications. Secondary endpoint was any adverse bleeding.


RESULTS
There were no deaths or major strokes. We observed 2 intraoperative TIA's (group II and III) and 1 postoperative minor stroke (group I). In comparison with placebo, Clopidogrel or Rheomacrodex in addition to Asasantin produced no significant reduction in the number of postoperative MES. There was no significant difference between the number of postoperative MES and different antiplatelet regimens. The incidence of bleeding complications was not significantly different between the 3 APT groups.


CONCLUSIONS
In the present study, we could not show a significant influence of different antiplatelet regimens on TCD detected postoperative embolization following CEA.
de Borst
G J
GJ
Department of Vascular Surgery, University Medical Centre Utrecht, The Netherlands. gjdeborst@hotmail.com
Hilgevoord
A A J
AA
de Vries
J P P M
JP
van der Mee
M
M
Moll
F L
FL
van de Pavoordt
H D W M
HD
Ackerstaff
R G A
RG
D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use*; D000068342:Aspirin, Dipyridamole Drug Combination; D000077144:Clopidogrel; D003911:Dextrans / Q000627:therapeutic use*; D004176:Dipyridamole / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D020766:Intracranial Embolism / Q000150:complications / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D002546:Ischemic Attack, Transient / Q000209:etiology; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging; D010865:Pilot Projects; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D011182:Postoperative Care; D011446:Prospective Studies; D020521:Stroke / Q000209:etiology; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial
D000925:Anticoagulants; D000068342:Aspirin, Dipyridamole Drug Combination; D003911:Dextrans; D004338:Drug Combinations; D010975:Platelet Aggregation Inhibitors; D004176:Dipyridamole; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin