Risk of wound hematoma at carotid endarterectomy under dual antiplatelet therapy.
Summary of "Risk of wound hematoma at carotid endarterectomy under dual antiplatelet therapy."
BACKGROUND AND
PURPOSE:
This study aims to assess perioperative incidence of wound hematoma and bleeding in patients who underwent carotid endarterectomy (CEA) under dual antiplatelet therapy.
METHODS:
Consecutive patients with initial CEA receiving aspirin, clopidogrel, or a combination of both were subjected to standard patch endarterectomy. Postoperative wound hematoma was assessed as moderate (subcutaneous bleeding, nonspace-occupying hematoma, and oozing suture bleeding) or severe, i.e., needing operative re-exploration.
RESULTS:
Six hundred eighty-four (80.9 %) patients with one of the three types of antiplatelet therapy out of 844 patients registered from 1995 to 2010 were enrolled. Wound hematoma occurred in 27 of 112 (24.1 %) patients under combined aspirin and clopidogrel, 33 of 162 (20.4 %) under clopidogrel, and 48 of 410 (11.7 %) under aspirin. Relative risk compared to aspirin was 2.4 (95 % CI, 1.4 to 4.1) for aspirin and clopidogrel and 1.9 (95 % CI, 1.2 to 3.1) for clopidogrel. Severe space-occupying hematoma needing operative re-exploration occurred in four (3.6 %) patients under aspirin and clopidogrel, seven (4.3 %) under clopidogrel, and five (1.2 %) under aspirin. Corresponding relative risks were 3.0 (95 % CI, 0.8 to 11.4) for aspirin and clopidogrel and 3.7 (95 % CI, 1.1 to 11.7) for clopidogrel. Relative risks remained without relevant change after adjustment for potentially confounding variables.
CONCLUSIONS:
Dual antiplatelet therapy with combined aspirin and clopidogrel as well as clopidogrel is associated with an increased incidence of perioperative wound hematoma compared to aspirin but on an acceptable low level of incidence. The latter may be achieved by adapting operative procedures to more intensive antiplatelet regimes.
Affiliation
Vascular and Stroke Center, Department of Neurology, Otto-von-Guericke University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany, andreas.oldag@med.ovgu.de.
Journal Details
This article was published in the following journal.
Name: Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie
ISSN: 1435-2451
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/22677970
- DOI: http://dx.doi.org/10.1007/s00423-012-0967-z
Medical and Biotech [MESH] Definitions
Endarterectomy, Carotid
The excision of the thickened, atheromatous tunica intima of a carotid artery.
Negative-pressure Wound Therapy
The application of a vacuum across the surface of a wound through a foam dressing cut to fit the wound. This removes wound exudates, reduces build-up of inflammatory mediators, and increases the flow of nutrients to the wound thus promoting healing.
Carotid Artery Injuries
Damages to the CAROTID ARTERIES caused either by blunt force or penetrating trauma, such as CRANIOCEREBRAL TRAUMA; THORACIC INJURIES; and NECK INJURIES. Damaged carotid arteries can lead to CAROTID ARTERY THROMBOSIS; CAROTID-CAVERNOUS SINUS FISTULA; pseudoaneurysm formation; and INTERNAL CAROTID ARTERY DISSECTION. (From Am J Forensic Med Pathol 1997, 18:251; J Trauma 1994, 37:473)
Carotid Artery Diseases
Pathological conditions involving the CAROTID ARTERIES, including the common, internal, and external carotid arteries. ATHEROSCLEROSIS and TRAUMA are relatively frequent causes of carotid artery pathology.
Hematoma, Epidural, Spinal
A rare epidural hematoma in the spinal epidural space, usually due to a vascular malformation (CENTRAL NERVOUS SYSTEM VASCULAR MALFORMATIONS) or TRAUMA. Spontaneous spinal epidural hematoma is a neurologic emergency due to a rapidly evolving compressive MYELOPATHY.
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