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.

absSec_2">Methods

abspara0015">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.

absSec_3">Results

abspara0020">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).

absSec_4">Conclusions

abspara0025">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.