Complication rates low among patients assigned anticoagulation, antiplatelet therapies undergoing CEA

Rosenbaum A. Ann Vasc Surg. 2010;doi:10.1016/j.avsg.2010.06.007.

Patients assigned anticoagulation and antiplatelet therapies who underwent carotid endarterectomy had a low rate of complications, including MI and stroke, according to data from a retrospective review.

“The number of cases involving patients undergoing vascular procedures who are prescribed clopidogrel or warfarin as treatment options continues to rise,” the researchers wrote. “Our aim was to examine outcomes related to antiplatelet or anticoagulation therapy in patients undergoing carotid endarterectomy. … Similar to previously published data, we reported a low incidence of perioperative stroke, MI and death in patients who underwent carotid endarterectomy and who were either on aspirin, clopidogrel or warfarin.”

Researchers from the Minneapolis Heart Institute Foundation performed the review, which included 260 consecutive patients (mean age, 69.3 years) who were undergoing carotid endarterectomy (CEA) between June 2006 and April 2009. Overall, 171 patients were assigned aspirin, 50 were assigned clopidogrel with or without aspirin, and 10 were assigned warfarin, with the remaining 29 patients not assigned any therapy.

During a mean follow-up of 406 days, researchers reported a complication rate of 7.3% and rates of 30-day stroke of 0.7% and stroke death of 1.1%. Overall, patients who were assigned aspirin, warfarin or clopidogrel had a low incidence of perioperative stroke, MI and death. Additionally, patients assigned clopidogrel were at the highest risk of complication, which the researchers attributed to the higher rates of neck hematomas among patients assigned the drug (16%) when compared with the other three arms (aspirin, 1.7%; warfarin, 0%; no therapy, 0%).

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