Carotid Endarterectomy and Concurrent Clopidogrel Use: US National Practice Patterns.

Carotid Endarterectomy and Concurrent Clopidogrel Use: US National Practice Patterns.

World Neurosurg. 2018 May 07;:

Authors: Mistry EA, Khoury JC, Kleindorfer D

Abstract
BACKGROUND: Patients diagnosed with high-grade carotid stenosis often receive a carotid endarterectomy (CEA) during their hospital stay and most receive antiplatelet medication. There is inter-surgeon variability in performing CEA in patients receiving clopidogrel given the potent antiplatelet effect.
METHODS: Utilizing the PREMIER database, adults with principal discharge diagnosis of stroke, transient ischemic attack (TIA) or carotid artery stenosis or occlusion without stroke/TIA(CAS), who had a CEA during the same hospital stay, in 2014 were analyzed. Recent clopidogrel or aspirin use was defined as within 3 days prior to CEA. Univariate and mutivariate analyses used to examine the association of age, race, gender, symptomatic vs asymptomatic carotid stenosis, academic vs non-academic center, and region of the US.
RESULTS: There were 15,381 patients [median age 71 years (IQR 65-78); 42% females] with stroke, TIA, or CAS who had a CEA during the same hospital stay in 2014; 2570 patients (16.7%) received clopidogrel, 4992 (32.5%) received aspirin but no clopidogrel, and 7819 (50.8%) received no clopidogrel/aspirin recently prior to CEA. Younger age, non-academic center, symptomatic carotid stenosis, and being in the Northeast or South conveyed higher odds of CEA with clopidogrel.
CONCLUSIONS: Across the US, 1 in 6 patients undergoing CEA have clopidogrel in their system. Symptomatic carotid stenosis convey the highest odds of CEA while on clopidogrel. Future systematic analysis of differences in outcomes and safety events are needed. Ultimately, appropriate education of practitioners involved in caring for these patients and studies to understand barriers to practice implementation are needed.

PMID: 29747016 [PubMed - as supplied by publisher]

https://ift.tt/2KR0Pb0