Combined clopidogrel and aspirin therapy in patients undergoing carotid endarterectomy is associated with an increased risk of postoperative bleeding

Abstract

This present study investigated the influence of combined preoperative clopidogrel and aspirin (ASA) administration on adverse postoperative outcomes and bleeding risk in patients undergoing carotid endarterectomy (CEA). A retrospective cohort study of all consecutive patients undergoing isolated CEA (n = 1488) between 1998 and 2005 was performed. Patients were classified into three groups: patients receiving combined preoperative clopidogrel/ASA therapy (n = 315), patients receiving preoperative ASA only (n = 639) and patients receiving no preoperative antiplatelet therapy (n = 518). Multivariate logistic regression was performed to determine if combined preoperative clopidogrel and ASA therapy is independently associated with improved perioperative outcomes after CEA in the absence of significant bleeding risk. Clopidogrel/ASA therapy was independently associated with a five-fold increased risk of postoperative bleeding after CEA (odds ratios = 5.1; 95% confidence intervals: 1.8–14.2; P < 0.002). No increase in bleeding risk or reoperation was observed in patients receiving ASA alone. However, the postoperative length of hospital stay (PLOHS) was significantly shorter (P = 0.01) for patients receiving combined clopidogrel/ASA therapy (2.5 ± 2.3 days) versus those receiving no antiplatelet agents (3.2 ± 5.9 days). Preoperative clopidogrel/ASA therapy increases risk of postoperative bleeding after CEA, yet reduces overall PLOHS.