Antiagregačná a antikoagulačná liečba pri karotickej endarterektómii.

Aim: The influence of commonly used antiplatelet agents and anticoagulants on hemorrhagic complications and the development of new ischemic brain lesions during carotid endarterectomies was studied. Material and Methods: During 559 carotid endarterectomies (CEA) antithrombotic therapy, as administrated by a referral doctor, was kept. The influence of antithrombotic therapy on: (A) incidence of wound hematoma with/without reoperation, (B) incidence of symptomatic intracerebral hematoma (ICH), (C) length of hospital stay and (D) incidence of new brain ischemic lesions was studied. Results: In total, wound hematoma was found in 43 (7,69%) cases. Of those there were (1) 2,94% in „no antithrombotic“ group, (2) 5,18% (p=0,55) in the ASA/ASA+ derivates group, (3) 18,36% (p=0,008) in clopidogrel group, (4) 0% in ticlopidin group, (5) 20% (p=0,022) in LMWH group, (6) 19,05% (p=0,026) in LMWH+ASA group, (7) 36,36% (p=0,003) in clopidogrel+ASA group. Incidence of symptomatic ICH after CEA was 0,89% (n=5).The mean length of hospital stay was 4.7 days for uncomplicated cases, 5.1 days for cases with hematoma w/o reoperation and 7.2 days for cases with hematoma with reoperation. Incidence of new ischemic lesions after CEA was 10,91%, not related to antithrombotic therapy (p>0.18).  Conclusion: Clopidogrel, LMWH and LMWH+ASA groups showed app. 4-times higher risk of wound hematoma, dual antiplatelet therapy 5.5-times higher compared to ASA therapy only. Therefore, their use preoperatively in CEA should be restricted for cases of symptomatic stenosis with high recurrent risk of stroke. No influence of antithrombotics on the incidence of new ischemic brain lesions during CEA was showed.