Karotid Endarterektomi Sonrası Kanamada Preoperatif Tekli ve İkili Antiplatelet Tedavinin Karşılaştırılması

Yıl 2019, Cilt: 22 Sayı: 3, 205 - 209, 24.12.2019

Özden Vezir Esra Ertürk

Öz

Giriş: Tekli veya ikili antiplatelet tedavi (TAPT veya İAPT), klinik semptomlar ve revaskülarizasyondan bağımsız olarak karotis arter darlığı (KAD) bulunan tüm hastalarda endikedir. Karotis endarterektomi (KEA) uygulanacak hastalarda preoperatif TAPT veya İAPT, cerrahi sırasında ve postoperatif dönemde kanama riskini arttırabilir. Özellikle klopidogrel kullanan hastalarda preoperatif tedavinin kesilmesi konusunda fikir birliği yoktur. Bu sorunun çözümüne katkıda bulunmayı amaçladık.

Hastalar ve Yöntem: Çalışmaya KEA uygulanan 54 hasta alındı ve retrospektif olarak değerlendirildi. Ameliyat öncesinde sadece aspirin içeren TAPT (TAPT grubu, n= 34) ve klopidogrel ile aspirini içeren İAPT (İAPT grubu, n= 20) kullanmış hastalardan iki farklı grup oluşturuldu. Hastalar tekrar eksplorasyon gerektiren perioperatif kanama, drenaj, hematom nedeniyle revizyon, kan ve kan ürünü kullanımı ve diğer komplikasyonlar (miyokart infarktüsü, kraniyal sinir hasarı ve ölüm) açısından değerlendirildi.

Bulgular: Perioperatif kanama ve drenaj miktarları İAPT grubunda 207.5 ± 90.4 mL, TAPT grubunda 177.9 ± 93.9 mL olarak ölçüldü ve gruplar karşılaştırıldığında anlamlı fark gözlenmedi (p= 0.263). İAPT grubundaki bir hasta kanama nedeniyle revize edildi ve TAPT grubundaki bir hasta hematom nedeniyle tekrar ameliyat edildi (p= 0.699). Hiçbir hastada miyokart infarktüsü, kraniyal sinir hasarı ve hastanede kalış süresi boyunca ölüm saptanmadı.

Sonuç: Nörolojik tarafta serebrovasküler olayların önlenmesinde primer olarak kullanılan klopidogrelin, kardiyovasküler cerrahi alanında da KEA planlanan hastalarda operasyon öncesi kesinti yapılmadan devam ettirilmesini öneriyoruz.

Anahtar Kelimeler

Karotid endarterektomi, klopidogrel, aspirin, kanama

Comparison of Preoperative Single and Dual Antiplatelet Therapy in Bleeding After Carotid Endarterectomy

Öz

Introduction: Single or dual antiplatelet therapy (SAPT or DAPT) is indicated in all patients with carotid artery stenosis (CAS), irrespective of clinical symptoms and revascularisation. In patients with carotid endarterectomy (CEA), SAPT or DAPT preoperatively may increase the risk of bleeding during surgery and postoperative period. There is no consensus regarding the discontinuation of preoperative treatment, especially in patients using clopidogrel. Our goal was to find the solution to this problem.

Patients and Methods: A total of 54 patients undergoing CEA were included in the study and evaluated retrospectively. Two different groups were formed: patients who used aspirin only in the preoperative treatment, containing SAPT (SAPT group, n= 34), and aspirin with clopidogrel, containing DAPT (DAPT group, n= 20). The patients were evaluated for perioperative bleeding, which needed re-exploration, drainage, revision due to haematoma, blood and blood-product change, or included other complications.

Results: Perioperative bleeding and drainage amounts were measured as 207.5 ± 90.4 cc in the DAPT group and 177.9 ± 93.9 cc in the SAPT group, and no significant difference was observed when the groups were compared (p= 0.263). One patient in the DAPT group was revised because of haemorrhage, and one patient in the SAPT group was re-operated due to haematoma (p= 0.699). No patients were found to have suffered myocardial infraction, cranial nerve damage, or death during hospital stay.

Conclusion: We recommend that clopidogrel in the prevention of cerebrovascular events in neurology should be primarily continued in the cardiovascular surgery without any interruption in patients with CEA.

Anahtar Kelimeler

Carotid endarterectomy, clopidogrel, aspirin, bleeding

Kaynakça

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