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Risk of wound hematoma at carotid endarterectomy under dual antiplatelet therapy.
MedLine Citation:
PMID:  22677970     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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.
Authors:
Andreas Oldag; Stephan Schreiber; Stefanie Schreiber; Hans-Jochen Heinze; Frank Meyer; Mathias Weber; Zuhir Halloul; Michael Goertler
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-6-8
Journal Detail:
Title:  Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie     Volume:  -     ISSN:  1435-2451     ISO Abbreviation:  -     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-6-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9808285     Medline TA:  Langenbecks Arch Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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.
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