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Risk of wound hematoma at carotid endarterectomy under dual antiplatelet therapy

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Abstract

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.

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Acknowledgment

We are grateful to Jane Heisinger for assistance in preoperative sonographic examinations and Annette Glaenzel for CEA register documentation.

Conflicts of interest

None.

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Authors and Affiliations

  1. Vascular and Stroke Center, Department of Neurology, Otto-von-Guericke University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany

    Andreas Oldag, Stephan Schreiber, Stefanie Schreiber, Hans-Jochen Heinze & Michael Goertler

  2. Vascular and Stroke Center, Department of General, Abdominal and Vascular Surgery, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany

    Frank Meyer, Mathias Weber & Zuhir Halloul

Authors
  1. Andreas Oldag
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  2. Stephan Schreiber
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  3. Stefanie Schreiber
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  4. Hans-Jochen Heinze
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  6. Mathias Weber
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  8. Michael Goertler
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Correspondence to Andreas Oldag.

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Oldag, A., Schreiber, S., Schreiber, S. et al. Risk of wound hematoma at carotid endarterectomy under dual antiplatelet therapy. Langenbecks Arch Surg 397, 1275–1282 (2012). https://doi.org/10.1007/s00423-012-0967-z

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  • DOI: https://doi.org/10.1007/s00423-012-0967-z

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