December 17, 2007

Safety of Carotid Endarterectomy in Patients Concurrently on Clopidogrel

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Mark D. Fleming, M.D., William M. Stone, M.D., Samuel R. Money, Richard J. Fowl, M.D..
Mayo Clinic, Phoenix, AZ, USA.

OBJECTIVES: Clopidogrel (Plavix®) usage is increasing primarily for management of patients with cerebrovascular symptoms and those receiving drug eluding coronary artery stents. A significant percentage of these patients will require carotid endarterectomy during their treatment and recent data has demonstrated a high incidence of coronary stent thrombosis when clopidogrel is discontinued. The objective of this study was to determine if carotid endarterectomy could be performed safely while patients are treated with clopidogrel.
METHODS: Over a 24-month period ending March 2007, 100 consecutive patients who underwent carotid endarterectomy were retrospectively reviewed. Patients were divided into two groups based on the perioperative use of clopidogrel. Preoperative demographics and postoperative results were compared between the two groups and statistically analyzed.
RESULTS: There were 19 patients actively taking clopidogrel prior to surgery and comprise the study group. The control group consisted of 81 patients who did not receive clopidogrel. Heparin anticoagulation was routinely utilized prior to clamping in both groups. Combined stroke/death was equivalent between the two groups (1.2 percent control versus 0 percent clopidogrel). One hematoma developed in the control group which did not require operative intervention. There were no statistical differences in morbidity or mortality between the control group and the Clopidogrel group.


	Control Group	Clopidogrel Group	p value
n	81	19
symptomatic	41 (50.6%)	10 (52.6%)	1.00
Post-operative CVA	0 (0%)	0(0%)	1.00
Post-operative TIA	2 (2.5%)	1 (5%)	0.472
Post-operative Hematoma	1 (1.2%)	0 (0%)	1.00
Post-operative MI	0 (0%)	1 (5%)	0.190
Mortality	1 (1.2%)	0 (0%)	1.00
EBL (mean)	98	122	0.310

CONCLUSION: In this series, our results suggest that patients concurrently on clopidogrel can safely undergo carotid endarterectomy without increased risk of hematoma or neurologic complications. In view of recent data demonstrating adverse outcomes in patients discontinuing clopidogrel, this study is useful in optimally managing this group of patients.

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