Carotid Endarterectomy on Antiplatelet Agents in the Era of Point-of-Care Testing

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• 作者：Karam Moon ; Michael Nanaszko ; Michael R. Levitt ; Bradley A. Gross ; Joseph M. Zabramski ; Robert F. Spetzler ; Peter Nakaji ; ^{Neuropub@dignityhealth.org" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Aspirin ; Carotid ; Clopidogrel ; Endarterectomy ; Hematoma ; Platelet aggregation inhibitors
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：93
• 期：Complete
• 页码：215-220
• 全文大小：2187 K

文摘

The safety of carotid endarterectomy in patients with a response to antiplatelet agents (aspirin and clopidogrel) confirmed by point-of-care testing is unknown. Thus, we sought to determine whether using point-of-care assessment of platelet inhibition reveals risk factors for operative complications or predicts clinical outcomes.

Methods

We reviewed records of carotid endarterectomy patients treated from March 2013 to July 2015 to extract demographics, lesion characteristics, laboratory data, procedural complications, and follow-up. Administration of aspirin, clopidogrel, or therapeutic anticoagulation within 5 days before surgery was recorded.

Results

We analyzed 79 patients with 86 lesions (mean age 70.9 ± 10.0 years). More patients with a P2Y₁₂ reaction unit (PRU) <170 had neck hematomas (4/10, 40.0%) than those with a PRU ≥170 (2/9, 22.2%) (P = 0.63). Estimated blood loss ≥100 mL was more frequent among patients with PRU <170 (9/10, 90.0%) than among those with PRU ≥170 (5/9, 55.6%) (P = 0.09). Clopidogrel use, regardless of response, independently predicted neck hematoma in a logistic regression model, with increased odds of 8.5. Mean postoperative modified Rankin Scale scores did not differ statistically between clopidogrel users and nonusers at a mean follow-up of 108.5 ± 146.3 days (P = 0.27).

Conclusions

Clopidogrel use within 5 days of carotid endarterectomy independently predicted postoperative neck hematomas, most of which were managed conservatively. Patients with PRU <170 were more likely to have estimated blood loss ≥100 mL during surgery and surgery lasting ≥3 hours.