title: Perioperative use of aspirin for patients undergoing carotid endarterectomy.
abstract: BACKGROUND
  This study was initiated to evaluate the cardiovascular benefit of perioperative use of acetylsalicylic acid (ASA) in patients undergoing carotid surgery.
  
  
  METHODS
  A prospective two-arm comparative study was conducted and focused on cardiac, neurological and bleeding complications for patients with high-grade (> 80 %) asymptomatic or symptomatic (> 60 %), internal carotid artery stenosis based on NASCET criteria who were treated by surgery. Between March 2008 and November 2010, 540 patients underwent carotid endarterectomy in two European vascular centers. In particular, 267 consecutive patients (49.4 %) had taken perioperative ASA in one center; in 273 consecutive patients in the other center ASA administration was stopped 5 days preoperatively.
  
  
  RESULTS
  The overall complication rate was lower in the ASA group (5.2 % versus 17.6 %), p < 0.001, 95 %CI [2.1;7.2], OR 3.8. In detail, the myocardial event rate was lower in the ASA arm: 0.7 versus 4.4 %; p = 0.012, OR 6.1 (95 %CI [1.4;27.45]. Concerning stroke, ASA patients benefit from oral antiaggregation as well: 1.5 vs. 5.5 %; p = 0.036), OR 4.5, 95 %CI[1.3;11.7], respectively. The bleeding complications were similar in both subgroups, 8 for the ASA group (3.0 %) and 10 (3.7 %) for the non-ASA group, p = 0.66. Multivariate logistic regression analysis showed significant benefit of the ASA-treatment in patients with hypertension, diabetes mellitus and hypercholesterolemia, p < 0.001. Additionally, female patients of the ASA group also had significantly less overall (p = 0.10, OR5.3), cardiac (p = 0.021, OR 3.6) and neurologic (p = 0.042, OR 6.7) complications. Bleeding risk was not higher in female patients receiving ASA (p = 0.25).
  
  
  CONCLUSIONS
  Perioperative use of ASA for patients undergoing carotid endarterectomy is associated with a lower risk of cardiac and neurological events without significant increase of postoperative bleeding necessitating revision.
authors: Department of Vascular Surgery, St. Franziskus Hospital Muenster, and Centre of Vascular and Endovascular Surgery, CVEC, Muenster University Hospital, Muenster, Germany. eva.schoenefeld@ukmuenster.de
authors: E
authors: E
authors: Schoenefeld
authors: K
authors: K
authors: Donas
authors: A
authors: A
authors: Radicke
authors: N
authors: N
authors: Osada
authors: M
authors: M
authors: Austermann
authors: G
authors: G
authors: Torsello
mesh_terms: D000284:Administration, Oral; D000368:Aged; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects; D002343:Carotid Artery, Internal / Q000601:surgery*; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D004334:Drug Administration Schedule; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005858:Germany; D006331:Heart Diseases / Q000209:etiology / Q000517:prevention & control; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D059035:Perioperative Period; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin