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Antiplatelet treatment after carotid artery stenting, surgery similar across European centers
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Preoperative and postoperative treatment regimens for antiplatelet therapy for carotid artery stenting or endarterectomy are similar across centers participating in an international trial, according to recent results.
Researchers evaluated responses to questionnaires sent to 77 sites, predominantly located throughout , participating in the ongoing ACST-2 trial. The study is assessing the use of antiplatelet treatment before, during and after carotid endarterectomy or carotid artery stenting. The questionnaires addressed the protocol for antiplatelet therapy employed at the sites, as well as whether facilities tested for resistance to antiplatelet treatments. Among the participating centers, 66 that performed carotid artery stenting and 61 that performed endarterectomy responded, for a total of 1,407 patients across 20 countries.
All but one of the centers performing stenting reported a protocol for preprocedural antiplatelet treatment, with 82% indicating the use of preoperative dual antiplatelet therapy. In 98% of centers prescribing preprocedural DAPT, the treatment included aspirin and clopidogrel. All patients who received carotid artery stenting were prescribed lifelong therapy with aspirin or clopidogrel, with DAPT initially used in 77% of centers, followed by lifelong therapy with a single antiplatelet medication. Lifelong DAPT was reported by 9% of participating centers.
For endarterectomy, 90% of participating sites indicated an existing protocol for preoperative antiplatelet therapy, with the majority (65%) reporting the use of aspirin alone. Preoperative DAPT was used in 31% of centers. The majority of facilities indicating the use of preoperative DAPT treated with aspirin and clopidogrel. All centers prescribed lifelong therapy with aspirin or clopidogrel after the procedure, with 24% prescribing postoperative DAPT for a specific period and 10% prescribing lifelong DAPT. The researchers wrote that the use of DAPT was significantly less common preoperatively and postoperatively for patients with endarterectomy than those who underwent carotid artery stenting (P < .05).
The researchers observed no significant differences in preprocedural antiplatelet therapy regimens according to region; however, they wrote, centers located in western Europe were more likely to prescribe lifelong DAPT after carotid artery stenting. Single antiplatelet therapy was prescribed by all facilities located in northern Europe and DAPT was prescribed throughout all centers in eastern Europe, whereas both types of treatments were used by countries in other regions.
Sixteen percent of participating centers reported testing for resistance to antiplatelet therapy. Testing for aspirin resistance specifically was performed in 11 participating facilities, six of which also reported testing for resistance to clopidogrel.
“Despite the lack of guidelines, there appears to be broad agreement among ACST-2 collaborators on the long-term use of antiplatelet therapy [in] patients undergoing carotid artery stenting and surgery,” the researchers concluded. “However, in the early postprocedural period some variation exists, with more [stenting] patients receiving DAPT.” – by Adam Taliercio
Disclosure: The researchers report no relevant financial disclosures.
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