Bridge-therapy with enoxaparin in the preoperative period of endarterectomy

Abstract

Cervical clot is one of the complications of endarterectomy. This risk may be higher in patients using aspirin or clopidogrel. On the other hand, stroke may occur if the medication is interrupted before surgery. We carried out a prospective study of 124 endarterectomies in 119 patients in which aspirin or clopidogrel was stopped and a bridge-therapy with enoxaparin was administered preoperatively. There was no case of stroke during the period of the bridge-therapy. One patient developed cervical clot (0.8%) in the fifth postoperative day. Mortality rate in this series was 0.8%. There was no complication directly related to the use of enoxaparin. Bridge-therapy with low molecular weight heparin is a safe strategy for patients elected for endarterectomy. Key words: antiplatelet drugs, cervical clot, endarterectomy, enoxaparin, stroke.terapia-ponte com enoxaparina no período pré-operatório da endarterectomia resumo Hematoma cervical é uma das complicações graves de endarterectomia. O risco dessa complicação pode ser maior em pacientes em uso de antiagregante plaquetário. Por outro lado, a suspensão de antiagregante plaquetário no período pré-operatório de endarterectomia eleva o risco de acidente vascular cerebral (AVC). Realizamos estudo prospectivo de 119 pacientes submetidos a endarterectomia (124 procedimentos), nos quais foi suspenso antiagregante plaquetário (aspirina ou clopidogrel) e foi administrada terapia-ponte com enoxaparina subcutânea no período pré-operatório. Nessa série, não houve ocorrência de AVC no período pré-operatório. Um paciente (0,8%) desenvolveu hematoma cervical no quinto dia pós-operatório. A mortalidade nessa série foi de 0,8%. Não houve nenhuma complicação atribuída diretamente ao uso de enoxaparina. A terapiaponte com heparina de baixo peso molecular demonstrou ser estratégia segura no preparo de pacientes para endarterectomia Palavras-chave: antiagregante plaquetário, AVC, endarterectomia, enoxaparina, hematoma cervical.

Extracranial–Intracranial Cerebral Revascularization: Indications and Results

“…The patients received bridge therapy with 40 mg subcutaneous enoxaparin, as done for endarterectomy. 4 Intraoperative monitoring, fluid loading, and choice of anesthetic agents were left to the discretion of the anesthesiologist, with the recommendation of maintaining normocapnia. All the patients were given antibiotics 1 hour before surgery through the first postoperative (PO) day.…”