The Use of Clopidogrel in Carotid Endarterectomy: An Audit of Current Practice

Abstract

Clopidogrel is commonly encountered in patients presenting for carotid endarterectomy (CEA). Its use around this time is controversial and there is no randomized control trial data to determine best practice. Questionnaires were posted to all members of the Vascular Society investigating clopidogrel use at the time of CEA. 52% discontinue clopidogrel preoperatively, with 51% of those using no alternative and 49% replacing it with aspirin. Clopidogrel use is not related to the number of endarterectomies performed by each surgeon. There is no consensus on clopidogrel use during CEA. This highlights the need for quality prospective data on this subject.

Predictors of Cervical Bleeding after Carotid Endarterectomy

“…Nonetheless, reversal with protamine was carried out in <50% of patients, and partially even in 28% of these, but these rates of use are similar to those reported on, 21 where 88% of the surgeons used routine intraoperative heparinization and only 13% routinely reversed it with protamine (17% selectively). However, in our study, neither intraoperative heparin employment nor intraoperative reversal with protamine, regardless of dosage, influenced the incidence of postoperative severe bleeding.…”

Predictors of neck bleeding after eversion carotid endarterectomy

“…11,13,15 Data to support either approach are limited and relate mainly to the literature on cardiothoracic procedures (in favor of discontinuing treatment), 14 or orthopedic and ocular surgery (favoring continued treatment). [30][31][32] A 2007 audit on the United Kingdom community of vascular surgeons investigated clopidogrel use at the time of CEA and established that 52% of surgeons discontinue it preoperatively, and 51% of them administer no alternative, whereas 49% replace it with ASA.…”

“…[30][31][32] A 2007 audit on the United Kingdom community of vascular surgeons investigated clopidogrel use at the time of CEA and established that 52% of surgeons discontinue it preoperatively, and 51% of them administer no alternative, whereas 49% replace it with ASA. 13 No data were available on how many days before CEA the treatment was stopped.…”

“…[6][7][8][9][10][11][12][13][14][15] Because there are increasingly broad indications in current clinical practice for antiplatelet agents as a primary or secondary prevention of cerebrovascular, peripheral vascular and coronary artery diseases, particularly after percutaneous coronary or peripheral artery procedures, 16 and for anticoagulants for atrial fibrillation, mechanical prosthetic valves, reduced left ventricular systolic function, left ventricular apical thrombus, and prior deep venous thrombosis or pulmonary embolism, 17 most patients requiring CEA are expected to be taking some form of AM. The advisability of AM near the time of CEA is controversial: many surgeons recommend that AM administration be continued to help prevent thrombotic events, whereas others prefer to discontinue AM to minimize the risk of perioperative bleeding.…”

“…The advisability of AM near the time of CEA is controversial: many surgeons recommend that AM administration be continued to help prevent thrombotic events, whereas others prefer to discontinue AM to minimize the risk of perioperative bleeding. 11,13,15 The aim of this study was to identify predictors of neck bleeding after eversion CEA (eCEA) to prevent this surgical complication.…”