Blood loss and complications following carotid endarterectomy in patients treated with clopidogrel

Abstract

This study assessed the effect of uninterrupted antiplatelet therapy on perioperative blood loss and complications in patients undergoing carotid endarterectomy. The files of 107 consecutive patients (mean age 69.5 ± 9 years; range 47-88; 78 men) who underwent carotid endarterectomy were reviewed. Twenty-six patients had been treated with clopidogrel (16 of whom were on combined clopidogrel and aspirin treatment) and compared with non-clopidogrel patients. Antiplatelet treatment was continued until the day of surgery without interruption. Perioperative blood loss and complications were studied. The mean hemoglobin decrease was 1.64 ± 1.2 mg/dL and was not significantly affected by clopidogrel. Surgical time was significantly longer among patients treated with clopidogrel (205 ± 52 minutes on combined treatment and 201 ± 68 minutes on clopidogrel alone versus 165 ± 33 minutes, P < 0.0001). Postoperative complications were similar for all groups and included five strokes, five neck hematomas, one nerve injury and one wound infection. In conclusion, patients treated with clopidogrel before carotid endarterectomy can be expected to have prolonged surgical time. Large cohorts are required to determine whether these patients have more complications.

Influence of local hemostatic and antiplatelet agents on the incidence of bleeding complications in carotid endarterectomies

“…In eight cases with revision surgery (40%) the patients were treated with clopidrogel perioperatively, five patients with a monotherapy and three in combination with ASA. Our results on an increased risk for revision surgery under clopidrogel perioperatively are in accordance with some [19,24] and contrary to some other [6,22] previous studies. The inconsistent data might be contributory to insufficient numbers of patients and different study design.…”

Clopidogrel Loading or Maintenance Before Carotid Endarterectomy is Not Risky for Post-operative Bleeding orWound Revision

“…In literature, some studies reported high major and minor complications rates due to small number of patients included. [25][26][27] Stone et al indicated that rate of bleeding that required re-operation due to clopidogrel use was 0.05% in 5264 CEA patients while bleeding due to clopidogrel and ASA combination was 1.5% and this rate was similar to the rate found in patients that did not use any antiaggregant therapy. However, bleeding due to use of ASA alone was 1.3%.…”

“…24 Forty nine percent of our CEA patients received ASA while 37% were on both ASA and clopidogrel therapy, and this rate was higher when compared to some smaller studies. [25][26][27] This may be related due to cautious approach of the authors to use clopidogrel. The vascular study group in The United Kingdom also agree with use of clopidogrel and its combinations.…”

“…33 Checkik et al reported that the use of clopidogrel did not have any adverse effects on bleeding, but it rather lengthened the time of the surgical procedure up to 330 m (205±52). 25 Rosenboum suggested that the duration of the operation in the control group was around 92 minutes while it lasted for 107 minutes in the clopidogreltreated group. The difference was found to be significant.…”

Regional Anaesthesia for Carotid Endarterectomy

“…15 Neither the incidence of clinically important neck haematoma 14 16 nor the morbidity rate from haemorrhagic complications increases in patients undergoing CEA taking clopidogrel with or without aspirin. 17 Surgery may take longer; 18 however, careful consideration should be given to the risks and benefits of performing regional anaesthesia in these patients. 19 There is no evidence available in the literature on the safety of performing CEA under GA or regional anaesthesia techniques in patients receiving newer, faster onset and offset antiplatelet drugs such as ticagrelor or prasugrel or any other of the newer oral anticoagulants.…”