Platelet Mapping and Desmopressin Reversal of Platelet Inhibition During Emergency Carotid Endarterectomy

C n E OSTOPERATIVE BLEEDING WITH cervical hematoma is a possible complication of carotid endarterectomy (CEA). ts incidence is about 5%, with 99% of the events occurring ithin 8 hours of the operation.1 A meta-analysis published in 2003 suggested that the risk for emorrhage was increased with platelet inhibition therapy but hat neurologic events were significantly decreased.2 A proonged surgical time from carotid artery flow restoration to skin losure (an indirect marker of hemostasis) in patients treated ith clopidogrel was observed in a recent prospective randomzed trial; however, the patients had a 10-fold reduction in the elative risk of having cerebral emboli in the postoperative eriod.3 Dual antiplatelet therapy with aspirin and clopidogrel is ore effective than aspirin alone in reducing asymptomatic miroembolization.4 Probably because of the limited risk of postoprative bleeding and evidence for a better neurologic outcome, a urvey in 2003 found that 90% of vascular surgeons in the United ingdom were not stopping antiplatelet therapy before a CEA.5 In cases requiring emergency CEA in patients receiving a lopidogrel loading dose, however, the risk of perioperative leeding and cervical hematoma may be increased. There is no lear information in the literature about the correct strategy for latelet function monitoring and control of bleeding in these ituations. Therefore, this case report addresses the issues, roposing a possible strategy for preventing perioperative leeding in patients receiving platelet inhibition therapy.