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Home > Vascular Annual Meeting > PP7. Pharamacological Management During Carotid...

PP7. Pharamacological Management During Carotid Endarterectomy

Maher Hamish, Manjit Gohel, Amanda Shepherd, Nathan J. Howes, Alun H. Davies
Charing Cross Hospital, Greater London, United Kingdom

OBJECTIVES: The peri-operative use of antiplatelet, anticoagulant and other drugs for patients undergoing carotid endarterectomy (CEA) is unclear and consensus is lacking. This study aimed to assess the current practice of European vascular surgeons with respect to antiplatelet and other medications.

METHODS: An online survey was conducted of members of the Vascular Society of Great Britain & Ireland and European Society for Vascular Surgery in 2008. Surgeons were asked about their preferences for the peri-operative administration of various medications for patients undergoing carotid endarterectomy.

RESULTS: Responses were received from 399 surgeons with a collective annual throughput of >11500 CEA procedures. For symptomatic and asymptomatic patients, 54/399 (14%) and 94/399 (24%) of surgeons would stop aspirin before surgery and 205/399 (54%) and 263/399 (66%) of surgeons would stop clopidogrel. Of surgeons who would stop clopidogrel, 84/205 (40%) and 121/205 (60%) would do so >7 days before surgery for symptomatic and asymptomatic patients respectively. 12/399 (3%) surgeons would add one dose of clopidogrel the night before surgery. Intra-operative Dextran was used selectively by 40/399 (10%). Only 54/399 (14%) would delay surgery to commence a statin. For patients taking dual antiplatelet medication, 13/399 (3%) of surgeons routinely use intraoperative platelets. Intraoperatively, 348/399 (87%) used intravenous heparin and this was reversed either routinely or selectively by 47/399 (12%) and 60/399 (15%) respectively.

CONCLUSIONS: There are wide variations between vascular surgeons in the pharamacological management of patients undergoing carotid endarterectomy. Further clinical studies may help clarify the optimum management strategy in this patient group.

AUTHOR DISCLOSURES: M. Hamish, None; M. Gohel, None; A. Shepherd, None; N.J. Howes, None; A.H. Davies, None.