POSTOPERATIVE ANTICOAGULANT AND ANTIAGGREGANT STRATEGY FOR THE PATIENTS WITH ATRIAL FIBRILLATION FOLLOWING CAROTID ENDARTERECTOMY - SINGLE CENTER EXPERIENCE

Year 2019, Volume: 82 Issue: 4, 174 - 179, 21.10.2019

Didem Melis Öztaş Murat Uğurlucan Hakkı Tankut Akay İbrahim Erdinç Kubilay Aydın Ufuk Alpagut

Abstract

Objective: Literature does not contain a standard procedure about anticoagulant therapy aimed at patients with atrial fibrillation and carotid artery stenosis following carotid endarterectomy. In this paper, we present our therapy modality at these patients in our clinic. Material and Method: The study includes 424 patients and 498 carotid endarterectomy operations performed by two surgeons with the same technique between June 2010 and December 2017. Fourty-five patients had chronic or paroxysmal atrial fibrillation. Therefore, the patients were receiving Coumadin and aspirin. The median age was 63.4±7.9. There were 27 female and 18 male patients. Thirty seven patients were hypertensive and 17 patients were diabetic. Nine patients underwent bilateral carotid endarterectomy operations. Thirty three patients were symptomatic. Eleven patients had coronary artery disease and 5 patients had cardiac valvular pathologies. Results: The whole carotid endarterectomy operations were performed under locoregional anesthesia. Early mortality occured in one patient because of hypertensive intracranial bleeding. The median follow up period was 68.4±19.2 months. One patient was lost due to aging and co-morbid factors and one patient was lost due to malignancy in late follow up period. Three patients required revisions for hematoma at incision region but an active bleeding focus could not be detected. There was no re-stenosis in any patient during follow-up. Conclusion: The large and multi-centered studies are needed for the anticoagulant therapy protocol for the patients with atrial fibrillation following carotid endarterectomy. We prefer combination of warfarin, providing INR value between 2-3, and 100 mg aspirin per day at our patients as therapy modality. 

Keywords

Carotid artery stenosis, atrial fibrillation, carotid endarterectomy

ATRİAL FİBRİLASYONU OLAN VE KAROTİS ENDARTEREKTOMİSİ GEÇİREN HASTALARDA POSTOPERATİF ANTİKOAGÜLAN VE ANTİAGREGAN STRATEJİSİ – TEK MERKEZ TECRÜBESİ

Abstract

Amaç: Karotis arter stenozu ve atriyal fibrilasyonun birarada görüldüğü hasta grubunda karotis endarterektomi sonrası antikoagülan tedavi protokolü ile ilgili standart bir prosedür bulunmamaktadır. Bu hasta grubunda kliniğimizde uyguladığımız tedavi stratejimizi sunmaktayız. Gereç ve Yöntem: Çalışma Haziran 2010 - Aralık 2017 arasında karotis endarterektomisi operasyonunu gerçekleştiren 2 cerrahın verilerinin toplandığı 424 hastayı ve 498 karotis endarterektomisi işlemini içermektedir. Bu hastaların 45’inde kronik veya paroksismal atriyal fibrilasyon mevcuttu. Hastalar warfarin ve aspirin tedavisi almaktaydı. Ortalama yaş 63,4±7,9 idi. Hastalardan 27’si kadın 18’i erkekti. 37 hastada hipertansiyon, 17 hastada diyabetes mellitus mevcuttu. Hastaların 9’una bilateral karotis arter stenozu nedeniyle cerrahi işlem uygulandı. 33 hasta semptomatikti. 11 hastada koroner arter hastalığı, 5 hastada kardiyak valvuler patoloji mevcuttu. Bulgular: Hastaların tamamında lokorejyonel anestezi ile karotis endarterektomisi yapıldı. Erken mortalite 1 hastada hipertansif intrakraniyal kanama sebebiyle gerçekleşti. Hastaları ortalama takip süresi 68,4±19,2 ay idi. Takiplerde 1 hastada komorbid faktörlere bağlı sebepler, 1 hastada malignite nedeniyle geç dönemde mortalite gerçekleşti. Hastaların 3’ünde insizyon böl gesinde hematom nedeniyle revizyon gerekti; fakat eksplorasyonda aktif kanama odağı tespit edilemedi. Hiçbir hastada takipleri sırasında restenoz saptanmadı. Tartışma: Atriyal fibrilasyonu olan hastalarda karotis endarterektomi sonrası antikoagülan tedavi protokolü açısından daha geniş ve çok merkezli çalışmalara gereksinim vardır. Biz hastalarımızda INR değerini 2-3 arasında tutacak şekilde warfarin tedavisi ile günlük 100 mg aspirin kombinasyonunu tedavi stratejisi olarak uygulamayı tercih ettik. 

Keywords

Karotis arter stenozu, atrial fibrilasyon, karotis endarterektomisi

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