Is Double Antiplatelet Therapy Protective While Waiting For Cea In Sympotmatic Patients

Introduction Carotid endarterectomy confers maximum benefit if performed in the first 14 days after an acute, non-cardioembolic ischemic stroke/transient ischemic attack (TIA). Nevertheless, there is considerable interest in whether there is a role for starting double antiplatelet (DAPT) therapy in the very early time period after symptom onset. Materials and Methods The authors conducted an observational retrospective analysis of all consecutive patients submitted to carotid endarterectomy (CEA) between 2010 and 2020 due to carotid artery symptomatic stenosis. Patients were allocated to Group I (acetylsalicylic acid alone), II (clopidogrel alone) or III (DAPT) considering the anti-platelet treatment they received during the period between the index event and CEA. Outcomes were recurrent TIA or stroke during the pre-operative period. Results We analysed 104 patient, 78 males, with a mean age of 70 years old. In Group I, we had 72 patients with 9 (13%) recurrent events. Group II had 14 patients with 1 (7%) recurrent event. Group III had 18 patients with no (0%) recurrent events. There was a significant (34%) RRR in recurrent TIA/ stroke events in patients receiving early DAPT, versus aspirin alone (0% vs. 13%, p < 0.01) and a (12%) RRR versus clopidogrel alone (0% vs. 7%, p <0.001). Conclusions The authors believe that aspirin plus clopidogrel might be more effective than either alone in AIT/stroke recurrence prevention in concordance with most significant publications from four RCT (Payen, CARESS, CLAIR and AMBDAP). DAPT may prevent spontaneous micro embolic signals, which are recognized marker of an increased risk of recurrent stroke in symptomatic patients.