Risk of wound hematoma at carotid endarterectomy under dual antiplatelet therapy.
OBJECTIVE
This study aims to assess perioperative incidence of wound hematoma and bleeding in patients who underwent carotid endarterectomy (CEA) under dual antiplatelet therapy.


METHODS
Consecutive patients with initial CEA receiving aspirin, clopidogrel, or a combination of both were subjected to standard patch endarterectomy. Postoperative wound hematoma was assessed as moderate (subcutaneous bleeding, nonspace-occupying hematoma, and oozing suture bleeding) or severe, i.e., needing operative re-exploration.


RESULTS
Six hundred eighty-four (80.9%) patients with one of the three types of antiplatelet therapy out of 844 patients registered from 1995 to 2010 were enrolled. Wound hematoma occurred in 27 of 112 (24.1%) patients under combined aspirin and clopidogrel, 33 of 162 (20.4%) under clopidogrel, and 48 of 410 (11.7 %) under aspirin. Relative risk compared to aspirin was 2.4 (95% CI, 1.4 to 4.1) for aspirin and clopidogrel and 1.9 (95% CI, 1.2 to 3.1) for clopidogrel. Severe space-occupying hematoma needing operative re-exploration occurred in four (3.6%) patients under aspirin and clopidogrel, seven (4.3%) under clopidogrel, and five (1.2%) under aspirin. Corresponding relative risks were 3.0 (95% CI, 0.8 to 11.4) for aspirin and clopidogrel and 3.7 (95% CI, 1.1 to 11.7) for clopidogrel. Relative risks remained without relevant change after adjustment for potentially confounding variables.


CONCLUSIONS
Dual antiplatelet therapy with combined aspirin and clopidogrel as well as clopidogrel is associated with an increased incidence of perioperative wound hematoma compared to aspirin but on an acceptable low level of incidence. The latter may be achieved by adapting operative procedures to more intensive antiplatelet regimes.
Vascular and Stroke Center, Department of Neurology, Otto-von-Guericke University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany. andreas.oldag@med.ovgu.de
Andreas
A
Oldag
Stephan
S
Schreiber
Stefanie
S
Schreiber
Hans-Jochen
HJ
Heinze
Frank
F
Meyer
Mathias
M
Weber
Zuhir
Z
Halloul
Michael
M
Goertler
D000368:Aged; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects*; D016063:Blood Loss, Surgical; D000077144:Clopidogrel; D004359:Drug Therapy, Combination; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006406:Hematoma / Q000139:chemically induced*; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D012086:Reoperation; D012307:Risk Factors; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin