O68: Long term stroke prevention drug therapy following Carotid endarterectomy (CEA) is good, but could be better

Introduction CEA reduces the risk of future stroke. The benefit is maximised with live-long drug therapy to reduce major adverse cardiovascular events (MACE), including stroke. Studies suggest around half discontinue these drugs within 12 months. We compared the drugs prescribed at CEA with those prescribed several years later. Methods Of 347 patients who underwent CEA between 2010-2019, at late follow-up (9+/-3.1y), 187 (54%) patients were alive. The prescription of generic MACE-reducing drugs (anti-thromboembolic, lipid-lowering, b-blockers and ACE-Inhibitors) and incidence of cardiovascular risk factors (hypertension, diabetes, ischaemic cardiac disease, stroke) at CEA were compared with that at late follow-up. Results At late follow-up, fewer were taking antiplatelet drugs (170v143 p<0.01), but more were formally anticoagulated (4v37 p<0.01). Overall there was no change in anti-thromboembolic prescription rates. Lipid-regulating drugs were equally highly prescribed at CEA and follow-up (169v173), Both B-blocker and ACE-Inhibitor prescriptions rates were low, but had increased by follow-up (46v69 p<0.01; 38v88 p<0.01). More patients were treated for hypertension at follow-up (67v166 p<0.01), but numbers with managed diabetes had not changed at late follow-up. 47 (25%) of patients had a history of ischaemic heart disease at CEA and 24 (14%) had developed new symptoms. There were 22 (12%) new strokes at late follow-up. Discussion Despite a higher than expected prescription rate of MACE-reducing drugs years after CEA, which is tailored to the patient’s changing needs, continued improvement is needed to optimise cardiovascular protection fully.