Outcomes related to antiplatelet or anticoagulation use in patients undergoing carotid endarterectomy.
BACKGROUND
The number of cases involving patients undergoing vascular procedures who are prescribed clopidogrel or warfarin as treatment options continues to rise. Our aim was to examine outcomes related to antiplatelet or anticoagulation therapy in patients undergoing carotid endarterectomy (CEA).


METHODS
A retrospective review of 260 consecutive patients undergoing CEA. Data including patient demographics, operative details, perioperative use of aspirin (ASA), clopidogrel, or warfarin, and early and/or late outcome(s) were collected. Endpoints included postoperative morbidity and/or mortality rate(s) and bleeding complications.


RESULTS
The study included 152 men and 108 women (mean age = 69.3 years), with a mean follow-up of 406 days. In all, 46% of endarterectomies were for a symptomatic disease. The technique of eversion endarterectomy was applied in 126 (48.5%), Dacron-patch in 112 (43.1%), and bovine pericardial-patch in 14 (5.4%) of the cases. Among the patients, 171 were taking ASA, 50 were taking clopidogrel ± ASA, and 10 were taking warfarin (mean INR = 1.62; range, 1.2-2.1); the remaining 29 were not on any antiplatelet therapy. All patients who were on warfarin therapy underwent an eversion endarterectomy. Overall, there were 19 (7.3%) complications (12 major and seven minor). The 30-day stroke rate and stroke death rate was 0.7% and 1.1%, respectively. Patients taking clopidogrel developed more number of neck hematomas (16% vs. 1.7%, p = 0.0004) compared with patients who were on ASA alone. For patients taking clopidogrel, Dacron-patch repair resulted in more hematomas than eversion endarterectomy (35% vs. 4.2%, p = 0.012). There was no difference in the incidence of neck hematoma on the basis of endarterectomy technique in patients who were on ASA alone. The patients taking warfarin neither had a perioperative complication nor developed a neck hematoma.


CONCLUSIONS
In this study, clopidogrel use during CEA resulted in a significant risk for developing a neck hematoma, particularly when using a Dacron-patch. The risk of a neck hematoma in patients who were on clopidogrel was much less when an eversion endarterectomy was performed.
Rosenbaum
Andrew
A
Department of Vascular and Endovascular Surgery, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, 55407, USA.
Rizvi
Adnan Z
AZ
Alden
Peter B
PB
Tretinyak
Alexander S
AS
Graber
John N
JN
Goldman
Jo Anne
JA
Sullivan
Timothy M
TM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D016009:Chi-Square Distribution; D000077144:Clopidogrel; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D009203:Myocardial Infarction / Q000209:etiology; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D019106:Postoperative Hemorrhage / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin