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There is a persistent, unresolved debate regarding the perioperative management of clopidogrel (Plavix) among patients undergoing carotid endarterectomy (CEA).
”Surgeons often have to decide whether or not to continue antiplatelet drugs at the time of carotid endarterectomy. Most feel comfortable continuing aspirin but there is uncertainty about how to manage patients on clopidogrel as well.
“Our goal was to try and address this frequently encountered problem in a way that helps surgeons decide how to manage these medications,” according to Dr. Douglas W. Jones of New York Presbyterian Hospital Weill-Cornell Medical Center, New York, and Dr. David H. Stone of Dartmouth-Hitchcock Medical Center.
Dr. Jones will reported on their study examining the impact of dual antiplatelet therapy (clopidogrel plus aspirin) on perioperative CEA outcomes in more than 34,000 patients treated over the period 2003 to 2014 at the 2015 Vascular Annual Meeting.
Among the 34,477 patients undergoing CEA in the Vascular Quality Initiative database, 63% (21,624) were on aspirin and 20% (7,059) were on clopidogrel and aspirin.
In order to isolate the effect of clopidogrel, patients on clopidogrel and aspirin (dual therapy) were compared to patients taking aspirin alone.
Multivariate analyses and propensity score matching were employed to control for subgroup heterogeneity. The outcomes of the study included reoperation for bleeding (RTOR), neurologic events (transient ischemic attack or stroke), stroke, death, myocardial infarction (MI), and stroke/death.
Dr. Jones and his colleagues found that those patients who were on dual therapy were significantly more likely to have multiple comorbidities, including coronary artery disease, congestive heart failure, COPD, as well as diabetes.
However, after controlling for these differences, multivariate analysis showed that dual therapy was independently and significantly associated with increased RTOR (OR 1.74), but was also significantly protective against neurologic events (OR 0.61), any stroke (OR 0.62), and stroke/death (0.65).
Further analysis with propensity score matching yielded 2 well-matched groups of 4,548 patients.
Propensity score matching confirmed that patients on dual therapy were more likely to return to the OR for bleeding but were less likely to suffer neurologic events, stroke, or stroke/death.
“Our study shows that continuation of clopidogrel at the time of CEA was associated with a near 40% reduction in neurologic events, but it exposed patients to an increased bleeding risk,” said Dr. Jones.
“Accordingly, surgeons must judiciously assess the perioperative risk/benefit trade-off at the time of CEA for patients on dual antiplatelet therapy,” he concluded.
There is a persistent, unresolved debate regarding the perioperative management of clopidogrel (Plavix) among patients undergoing carotid endarterectomy (CEA).
”Surgeons often have to decide whether or not to continue antiplatelet drugs at the time of carotid endarterectomy. Most feel comfortable continuing aspirin but there is uncertainty about how to manage patients on clopidogrel as well.
“Our goal was to try and address this frequently encountered problem in a way that helps surgeons decide how to manage these medications,” according to Dr. Douglas W. Jones of New York Presbyterian Hospital Weill-Cornell Medical Center, New York, and Dr. David H. Stone of Dartmouth-Hitchcock Medical Center.
Dr. Jones will reported on their study examining the impact of dual antiplatelet therapy (clopidogrel plus aspirin) on perioperative CEA outcomes in more than 34,000 patients treated over the period 2003 to 2014 at the 2015 Vascular Annual Meeting.
Among the 34,477 patients undergoing CEA in the Vascular Quality Initiative database, 63% (21,624) were on aspirin and 20% (7,059) were on clopidogrel and aspirin.
In order to isolate the effect of clopidogrel, patients on clopidogrel and aspirin (dual therapy) were compared to patients taking aspirin alone.
Multivariate analyses and propensity score matching were employed to control for subgroup heterogeneity. The outcomes of the study included reoperation for bleeding (RTOR), neurologic events (transient ischemic attack or stroke), stroke, death, myocardial infarction (MI), and stroke/death.
Dr. Jones and his colleagues found that those patients who were on dual therapy were significantly more likely to have multiple comorbidities, including coronary artery disease, congestive heart failure, COPD, as well as diabetes.
However, after controlling for these differences, multivariate analysis showed that dual therapy was independently and significantly associated with increased RTOR (OR 1.74), but was also significantly protective against neurologic events (OR 0.61), any stroke (OR 0.62), and stroke/death (0.65).
Further analysis with propensity score matching yielded 2 well-matched groups of 4,548 patients.
Propensity score matching confirmed that patients on dual therapy were more likely to return to the OR for bleeding but were less likely to suffer neurologic events, stroke, or stroke/death.
“Our study shows that continuation of clopidogrel at the time of CEA was associated with a near 40% reduction in neurologic events, but it exposed patients to an increased bleeding risk,” said Dr. Jones.
“Accordingly, surgeons must judiciously assess the perioperative risk/benefit trade-off at the time of CEA for patients on dual antiplatelet therapy,” he concluded.
There is a persistent, unresolved debate regarding the perioperative management of clopidogrel (Plavix) among patients undergoing carotid endarterectomy (CEA).
”Surgeons often have to decide whether or not to continue antiplatelet drugs at the time of carotid endarterectomy. Most feel comfortable continuing aspirin but there is uncertainty about how to manage patients on clopidogrel as well.
“Our goal was to try and address this frequently encountered problem in a way that helps surgeons decide how to manage these medications,” according to Dr. Douglas W. Jones of New York Presbyterian Hospital Weill-Cornell Medical Center, New York, and Dr. David H. Stone of Dartmouth-Hitchcock Medical Center.
Dr. Jones will reported on their study examining the impact of dual antiplatelet therapy (clopidogrel plus aspirin) on perioperative CEA outcomes in more than 34,000 patients treated over the period 2003 to 2014 at the 2015 Vascular Annual Meeting.
Among the 34,477 patients undergoing CEA in the Vascular Quality Initiative database, 63% (21,624) were on aspirin and 20% (7,059) were on clopidogrel and aspirin.
In order to isolate the effect of clopidogrel, patients on clopidogrel and aspirin (dual therapy) were compared to patients taking aspirin alone.
Multivariate analyses and propensity score matching were employed to control for subgroup heterogeneity. The outcomes of the study included reoperation for bleeding (RTOR), neurologic events (transient ischemic attack or stroke), stroke, death, myocardial infarction (MI), and stroke/death.
Dr. Jones and his colleagues found that those patients who were on dual therapy were significantly more likely to have multiple comorbidities, including coronary artery disease, congestive heart failure, COPD, as well as diabetes.
However, after controlling for these differences, multivariate analysis showed that dual therapy was independently and significantly associated with increased RTOR (OR 1.74), but was also significantly protective against neurologic events (OR 0.61), any stroke (OR 0.62), and stroke/death (0.65).
Further analysis with propensity score matching yielded 2 well-matched groups of 4,548 patients.
Propensity score matching confirmed that patients on dual therapy were more likely to return to the OR for bleeding but were less likely to suffer neurologic events, stroke, or stroke/death.
“Our study shows that continuation of clopidogrel at the time of CEA was associated with a near 40% reduction in neurologic events, but it exposed patients to an increased bleeding risk,” said Dr. Jones.
“Accordingly, surgeons must judiciously assess the perioperative risk/benefit trade-off at the time of CEA for patients on dual antiplatelet therapy,” he concluded.