Abstract
Introduction In the Netherlands, clopidogrel monotherapy increasingly replaces acetylsalicylic
acid and extended release dipyridamole as the first-choice antiplatelet therapy after
ischemic stroke. It is unknown whether the risk of peri- and postoperative hemorrhage
in carotid artery surgery is higher in patients using clopidogrel monotherapy compared
with acetylsalicylic acid and extended release dipyridamole. We therefore retrospectively
compared occurrence of perioperative major and (clinical relevant) minor bleedings
during and after carotid endarterectomy of two groups using different types of platelet
aggregation inhibition after changing our daily practice protocol in our center.
Material and Methods A consecutive series of the most recent 80 carotid endarterectomy patients (November
2015–August 2017) treated with the new regime (clopidogrel monotherapy) were compared
with the last 80 (January 2012–November 2015) consecutive patients treated according
to the old protocol (acetylsalicylic acid and dipyridamole). The primary endpoint
was any major bleeding during surgery or in the first 24 to 72 hours postoperatively.
Secondary outcomes within 30 days after surgery included minor (re)bleeding postoperative
stroke with persistent or transient neurological deficit, persisting or transient
neuropraxia, asymptomatic restenosis or occlusion, (transient) headache. Reporting
of this study is in line with the ‘Strengthening the Reporting of Observational Studies
in Epidemiology’ statement.
Results Although statistical differences were observed, from a clinical perspective both
patients groups were comparable. Postoperative hemorrhage requiring reexploration
for hemostasis occurred in none of the 80 patients in the group of the clopidogrel
monotherapy (new protocol) and it occurred in one of the 80 patients (1%) who was
using acetylsalicylic acid and dipyridamole (old protocol). In three patients (4%)
in the clopidogrel monotherapy and one patient (1%) in the acetylsalicylic acid and
extended release dipyridamole protocol an ipsilateral stroke was diagnosed.
Conclusion In this retrospective consecutive series the incidence of postoperative ischemic
complications and perioperative hemorrhage after carotid endarterectomy (CEA) seemed
to be comparable in patients using clopidogrel monotherapy versus acetylsalicylic
acid and extended release dipyridamole for secondary prevention after a cerebrovascular
event. This study fuels the hypothesis that short- and midterm complications of clopidogrel
and the combination acetylsalicylic acid and extended release dipyridamole are comparable.
Keywords
acetylsalicylic acid - ASA - bleeding - carotid endarterectomy - carotid artery -
clopidogrel - dipyridamole - complication
