Effect of perioperative platelet inhibition on postcarotid endarterectomy mural thrombus formation

Abstract

A prospective randomized double-blind trial was conducted to study the effect of platelet-inhibiting drugs on mural thrombus formation after carotid endarterectomy. Twenty-two patients undergoing carotid endarterectomy were randomly assigned to perioperative administration of an aspirin/dipyridamole combination or a placebo, and the postoperative results were compared. Autologous indium-111-labeled platelets were injected postoperatively, and platelet deposition was measured at the endarterectomy site. It was found that the treated group had a significant reduction in platelet accumulation compared with the placebo group. The results suggest that the perioperative use of aspirin/dipyridamole may reduce the risk of operative stroke and the long-term risk of repeat carotid stenosis.

Antithrombotic Therapy for Peripheral Artery Occlusive Disease

“…Scintigraphic studies with indium-111 labeled platelets document marked deposition of platelets at the endarterectomy site immediately after operation. 164,165 The intensity of platelet accumulation decreases over time, possibly because of reendothelialization of the endarterectomy site. In one study of 22 patients, treatment of patients undergoing carotid endarterectomy with aspirin plus dipyridamole significantly decreased indium-111 platelet deposition and appeared to decrease the incidence of perioperative stroke.…”

“…In one study of 22 patients, treatment of patients undergoing carotid endarterectomy with aspirin plus dipyridamole significantly decreased indium-111 platelet deposition and appeared to decrease the incidence of perioperative stroke. 165 In a study of 125 patients assessing the benefit of aspirin therapy for longer periods after carotid endarterectomy 166 patients receiving aspirin, 650 mg bid started on the fifth postoperative day had a slight but significant reduction in unfavorable endpoints when considered together (continuing TIAs, stroke, retinal infarction, and death from stroke) during a 2-year follow-up period in comparison with control subjects receiving placebo. This experience contrasts with that of a randomized trial of 301 patients comparing low-dose aspirin therapy, 50 -100 mg/d, with placebo after carotid endarterectomy.…”

Antithrombotic Drugs and Vascular Surgery

“…104 Aspirin therapy is an important adjunct to patients undergoing carotid endarterectomy Studies with indium-111-labeled platelets document marked deposition of platelets at the endarterectomy site immediately after operation. 105,106 The intensity of platelet accumulation decreases over time, presumably because of healing and reendothelialization of the endarterectomy site. In one study of patients undergoing carotid endarterectomy, treatment with aspirin plus dipyridamole significantly decreased labeled platelet deposition and appeared to decrease the incidence of perioperative stroke.…”

Antithrombotic Therapy in Peripheral Arterial Occlusive Disease

“…Scintigraphic studies with 111 In-labeled platelets document marked deposition of platelets at the endarterectomy site immediately after operation. 191,192 The intensity of platelet accumulation decreases over time, possibly because of re-endothelialization of the endarterectomy site. 191 In one study of 22 patients, treatment of patients undergoing carotid endarterectomy with aspirin plus dipyridamole significantly decreased 111 In-labeled platelet deposition and appeared to decrease the incidence of perioperative stroke.…”

“…191 In one study of 22 patients, treatment of patients undergoing carotid endarterectomy with aspirin plus dipyridamole significantly decreased 111 In-labeled platelet deposition and appeared to decrease the incidence of perioperative stroke. 192 A study of 125 patients in which the benefit of aspirin therapy for longer periods after carotid endarterectomy was assessed has been reported. 193 Patients receiving aspirin, 650 mg twice daily started on the fifth postoperative day, had a slight but significant reduction in unfavorable end points when considered together (continuing transient ischemic attacks, stroke, retinal infarction, and death from stroke) during a 2-year follow-up period in comparison with control subjects receiving placebo.…”