Comparison of Preoperative Single and Dual Antiplatelet Therapy in Bleeding After Carotid Endarterectomy

Abstract

Introduction: Single or dual antiplatelet therapy (SAPT or DAPT) is indicated in all patients with carotid artery stenosis (CAS), irrespective of clinical symptoms and revascularisation. In patients with carotid endarterectomy (CEA), SAPT or DAPT preoperatively may increase the risk of bleeding during surgery and postoperative period. There is no consensus regarding the discontinuation of preoperative treatment, especially in patients using clopidogrel. Our goal was to find the solution to this problem. Patients and Methods: A total of 54 patients undergoing CEA were included in the study and evaluated retrospectively. Two different groups were formed: patients who used aspirin only in the preoperative treatment, containing SAPT (SAPT group, n= 34), and aspirin with clopidogrel, containing DAPT (DAPT group, n= 20). The patients were evaluated for perioperative bleeding, which needed re-exploration, drainage, revision due to haematoma, blood and blood-product change, or included other complications. Results: Perioperative bleeding and drainage amounts were measured as 207.5 ± 90.4 cc in the DAPT group and 177.9 ± 93.9 cc in the SAPT group, and no significant difference was observed when the groups were compared (p= 0.263). One patient in the DAPT group was revised because of haemorrhage, and one patient in the SAPT group was re-operated due to haematoma (p= 0.699). No patients were found to have suffered myocardial infraction, cranial nerve damage, or death during hospital stay. Conclusion: We recommend that clopidogrel in the prevention of cerebrovascular events in neurology should be primarily continued in the cardiovascular surgery without any interruption in patients with CEA.