Cranial nerve injury is associated with dual antiplatelet therapy use and cervical hematoma after carotid endarterectomy

Chisci, Emiliano; Rehring, Thomas F.; Pigozzi, Clara; Colon, Serena; Borgheresi, Alessandra; Tramacere, Luciana; Ercolini, Leonardo; Michelagnoli, Stefano

doi:10.1016/j.jvs.2016.04.029

Cited by 12 publications

(17 citation statements)

References 22 publications

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“…Following abstract and full text screening, eight studies were included for analysis. 9,11,15,25e29 In addition, the authors of nine articles responded to the request for additional information, 6,30e37 and these were added if they met the inclusion criteria, 31,32,36 resulting in a total of 11 articles (Table 1). Across these studies, there were 47 411 patients, with 33 066 (69.7%) in the aspirin arm and 14 345 (30.3%) patients in the DAPT arm.…”

Section: Resultsmentioning

confidence: 99%

“…Across these studies, there were 47 411 patients, with 33 066 (69.7%) in the aspirin arm and 14 345 (30.3%) patients in the DAPT arm. Studies reported in hospital or peri-operative outcomes 9,25,28,31 or 30 day outcomes, 15,26,32 and these were pooled for statistical analysis. The overall level of evidence was low.…”

Section: Resultsmentioning

confidence: 99%

“…There were only two randomised control trials (RCTs). 26,29 The remaining studies were retrospective 9,11,15,27,28,31,32 or prospective cohort studies. 25,36 All retrospective studies were graded as level 4, prospective studies with historical controls graded as level 3, and the RCTs were graded as level 2.…”

Section: Resultsmentioning

confidence: 99%

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Editor's Choice – Peri-Operative Outcomes of Carotid Endarterectomy are Not Improved on Dual Antiplatelet Therapy vs. Aspirin Monotherapy: A Systematic Review and Meta-Analysis

Taslimi

Zuccato

et al. 2022

European Journal of Vascular and Endovascular Surgery

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Editor's Choice – Peri-Operative Outcomes of Carotid Endarterectomy are Not Improved on Dual Antiplatelet Therapy vs. Aspirin Monotherapy: A Systematic Review and Meta-Analysis

Taslimi

Zuccato

et al. 2022

European Journal of Vascular and Endovascular Surgery

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“…Perioperative cranial nerve injury was reported in 2.2% to 5.6% of cases. [26][27][28] A recent review of cranial nerve injury after CEA reported rates of vagus nerve injury, hypoglossal…”

Section: Discussionmentioning

confidence: 99%

Outcomes of mini-incision eversion carotid endarterectomy combined with nontouch isolation technique of the internal carotid artery

Shukuzawa

Ohki

Kanaoka

et al. 2018

Journal of Vascular Surgery

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“…Despite recent controversy about the bleeding risk associated with perioperative clopidogrel use in vascular surgery (particularly for carotid endarterectomy [CEA]), 12–18 it has become increasingly clear that clopidogrel is associated with bleeding complications. Compared with LEB, bleeding after CEA is less likely to be associated with transfusion and more likely to lead to reoperation because of the severe consequences of ongoing blood loss.…”

Section: Discussionmentioning

confidence: 99%

Perioperative clopidogrel is associated with increased bleeding and blood transfusion at the time of lower extremity bypass

Jones¹,

Schermerhorn²,

Brooke

et al. 2017

Journal of Vascular Surgery

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Objective Controversy persists surrounding the perceived bleeding risk associated with perioperative clopidogrel use in patients undergoing lower extremity bypass (LEB). The purpose of this study was to examine the LEB bleeding risk and clinical sequelae associated with clopidogrel. Methods All LEBs in the Vascular Quality Initiative (VQI) from 2008 to 2014 were studied. The exposure was perioperative clopidogrel. Primary outcomes were blood transfusion, estimated blood loss ≥500 mL, and reoperation for bleeding. Secondary outcomes included mean operative time, major cardiac events, respiratory complications, infectious complications, and in-hospital mortality. Univariate and multivariable analyses were used to analyze patients on the basis of clopidogrel use and its association with outcomes. Nonparametric test for trend and Mantel-Haenszel methods were used to analyze association of clopidogrel use with blood transfusion and secondary outcomes. Results Among the LEB cohort (N = 9179), 28% (n = 2544) were taking clopidogrel and 72% (n = 6635) were not. Patients taking clopidogrel were more likely to have coronary disease, prior coronary intervention, abnormal findings on stress test, and aspirin use (P < .001 for all). Patients taking clopidogrel were more likely to receive blood transfusion (38% vs 24%; P < .001) and to have estimated blood loss ≥500 mL (21% vs 12%; P < .001). Reoperation for bleeding rates were similar (0.9% vs 1.1%; P = .9). Clopidogrel use was also associated with increased mean operative times (244 minutes vs 232 minutes; P < .001) as well as with cardiac complications (8.8% vs 6.5%; P = .001), respiratory complications (2.5% vs 1.6%; P = .007), and in-hospital mortality (1.3% vs 0.8%; P = .03). Multivariable analysis demonstrated that clopidogrel was associated with increased risk of 1- or 2-unit blood transfusion (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.5–2.1; P < .001) and >2-unit blood transfusion (OR, 2.0; 95% CI, 1.7–2.5; P < .001). Major cardiac events (OR, 1.2; 95% CI, 1.0–1.5; P = .05) and respiratory complications (OR, 1.4; 95% CI, 1.0–2.0; P = .03) were also independently associated with clopidogrel use. Weighted Mantel-Haenszel ORs controlling for blood transfusion amount revealed no remaining effect of clopidogrel on major cardiac events (OR, 1.1; P = .4) or respiratory complications (OR, 1.0; P = .8). Conclusions Perioperative clopidogrel use in LEB surgery is associated with increased blood loss and blood transfusion. Associated clinical sequelae include increased cardiac and pulmonary complications. Accordingly, surgeons should consider discontinuation of perioperative clopidogrel when it is clinically appropriate unless it is strongly indicated at the time of LEB.

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Cranial nerve injury is associated with dual antiplatelet therapy use and cervical hematoma after carotid endarterectomy

Abstract: CNI is predominantly a transient complication, but is associated significantly with dual antiplatelet therapy use and the occurrence of a postoperative cervical hematoma. Scrupulous attention to hemostasis might reduce the incidence of CNI.

Cited by 12 publications

References 22 publications

Editor's Choice – Peri-Operative Outcomes of Carotid Endarterectomy are Not Improved on Dual Antiplatelet Therapy vs. Aspirin Monotherapy: A Systematic Review and Meta-Analysis

Editor's Choice – Peri-Operative Outcomes of Carotid Endarterectomy are Not Improved on Dual Antiplatelet Therapy vs. Aspirin Monotherapy: A Systematic Review and Meta-Analysis

Outcomes of mini-incision eversion carotid endarterectomy combined with nontouch isolation technique of the internal carotid artery

Perioperative clopidogrel is associated with increased bleeding and blood transfusion at the time of lower extremity bypass

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