Antiplatelet agents and risk factors for bleeding postcarotid endarterectomy.
BACKGROUND
Antiplatelet therapy has been implicated as a risk factor for wound hematoma formation after carotid endarterectomy (CEA). Given the increasing use of alternative antiplatelet drugs acting through differing inhibitory pathways, we audited the incidence of re-operation for bleeding post-CEA.


METHODS
Data were prospectively recorded on all patients undergoing CEA in Leicester, United Kingdom between November 1997 and October 2001. The data from those requiring exploration for bleeding were studied on a case-controlled basis using paired age and sex-matched controls from within the overall database. Assessment of the patients' demographics, drug history, and intraoperative and postoperative care was made.


RESULTS
A total of 448 patients were reviewed and 27 (6.03%) cases of postoperative bleeding were identified which required exploration. Despite the prevalent use of antiplatelet drugs before surgery, there was no increased risk of bleeding associated with their use identified on univariate analysis. Patients who underwent re-exploration for bleeding had a significantly greater prevalence of post-CEA hypertension (21/27 cases vs. 25/54 controls, respectively; p = 0.014). Patients who underwent surgical re-exploration for bleeding also had a greater transfusion requirement (1.33 ± 1.3 vs. 0.02 ± 0.1 units; p ≤ 0.0001) and a longer hospital stay (4.9 ± 2.2 days vs. 2.9 ± 2.3 days; p = 0.001) although there was no increase in morbidity or mortality.


CONCLUSIONS
The use of newer antiplatelet drugs before surgery was not associated with an increased risk of bleeding after CEA in this study. Tight control of blood pressure, both pre- and postsurgery, appears to be important, and a protocol for the management of this condition is recommended.
Payne
David A
DA
Department of Cardiovascular Sciences, Leicester Royal Infirmary, Infirmary Square, Leicester, United Kingdom.
Twigg
Michael W
MW
Hayes
Paul D
PD
Naylor
A Ross
AR
D000368:Aged; D001803:Blood Transfusion; D016009:Chi-Square Distribution; D054869:Clinical Audit; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D004739:England; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000209:etiology; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors