Key result
Pre-op aspirin and post-op DAPT linked to 1.6% one-month stroke or death after carotid endarterectomy.
Why the study?
There is currently no consensus regarding the optimal perioperative antiplatelet strategy for carotid artery surgery.
Does preoperative aspirin monotherapy followed by postoperative DAPT prevent stroke or death in patients undergoing carotid endarterectomy?
Cohort (n=821)
Yes
Does preoperative aspirin monotherapy followed by postoperative DAPT prevent stroke or death in patients undergoing carotid endarterectomy?
Preoperative aspirin monotherapy followed by postoperative DAPT is associated with a low 1-month rate of stroke or death (1.6%) in patients undergoing carotid endarterectomy.
May support this regimen in carotid endarterectomy; hypothesis-generating and requires randomized confirmation before practice change.
Background: There is currently no consensus regarding the optimal perioperative antiplatelet strategy for carotid artery surgery. This multicentre study aimed to analyse the association between preoperative aspirin monotherapy following postoperative dual antiplatelet therapy (DAPT) and the risk for stroke and death after carotid endarterectomy (CEA). Methods: This cohort study included 821 patients with carotid artery stenosis who underwent CEA. Primary outcomes included any stroke or death up to the one-month postoperative follow-up. Multilevel multivariate regression analyses and descriptive statistics were performed. Results: Patients were predominantly male (53 %), with a mean age of 66.2 years. The primary outcome occurred in 1.6 % of patients. Univariate and multivariate analyses revealed that patients with chronic obstructive pulmonary disease (COPD) exhibited a high risk for stroke or death (P = 0.011). The occurrence of any local complications in the neck was accompanied by an increase in diastolic blood pressure (DBP) (P = 0.007). Patients with a high systolic blood pressure (SBP) (P = 0.002) experienced a longer operative duration. The length of hospital stay was longer in the patients with COPD (P = 0.020), minor stroke (P = 0.011), and major stroke (P = 0.001). A positive linear correlation was found between SBP and operative duration in the overall population (β 0.4 [95 % confidence interval (CI) 0.1-0.7]; P = 0.002). The resultant curve for DBP and any local complications in the neck exhibited a two-stage change and one breakpoint in the entire population (k = 68 mmHg, <68; odds ratio [OR] 0.9 [95 % CI 0.7-1.1], P = 0.461; ≥68: OR 1.1 [95 % CI 1.0-1.1], P = 0.003). Conclusions: Preoperative aspirin monotherapy and postoperative DAPT were safe and effective antiplatelet treatments for patients who underwent CEA.
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Han et al. (2024) conducted a cohort in carotid artery stenosis (n=821). Preoperative aspirin monotherapy and postoperative dual antiplatelet therapy (DAPT) was evaluated on any stroke or death up to the one-month postoperative follow-up. Preoperative aspirin monotherapy and postoperative DAPT in patients undergoing carotid endarterectomy was associated with a 1.6% rate of stroke or death at one month.
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