Is there Risk of Bleeding After Carotid Endarterectomy with dual antiplatelet therapy?

May of us are concerned about the unexpected bleeding after carotid endarterectomy. Some times suture needle puncture bleeds for a long time after endarterectomy. Some of  us assume that this could be more if the patient is on two or more anti platelet drugs preoperatively. Most of these patients might have already undergone coronary stenting procedures earlier. The cardiologist would like to  continue the antiplatelet drugs in perioperative period as there is risk of stent thrombosis in the absence of these drugs. Giulio Illuminati et al recently published their data related to the safety of using dual antiplatelet therapy in the carotid endarterectomy patients. 188 patients received dual anti platelet drugs (Aspirin 100mg, Clopidogrel 75mg) and Inj. LMWH- 2000 units B.D (till discharge) in the post operative period, started 6 hours after surgery without any complications. There were no postoperative cervical hematomas requiring surgical evacuation. There was one hypoglossal nerve palsy, which regressed within 2 weeks. There was no postoperative mortality and neurologic and cardiac morbidity.
This study is too good to believe and I am sure some surgeons will be still apprehensive to use this regimen after carotid endarterectomy in their practice.

Reference:
1) Giulio Illuminati, Fabrice Schneider, Giulia Pizzardi, Federica Masci, Francesco G. Calio', Jean-Baptiste Ricco. Dual Antiplatelet Therapy Does Not Increase the Risk of Bleeding After Carotid Endarterectomy: Results of a Prospective Study. Annals of Vascular Surgery. 2017; 40:39 - 43

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Giulio Illuminati

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Affiliations

• The Department of Surgical Sciences, University of Rome “La Sapienza”, Rome, Italy

Correspondence

• Correspondence to: Giulio Illuminati, MD, The Department of Surgical Sciences, University of Rome “La Sapienza”, Via Vincenzo Bellini 14, Rome 00198, Italy