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Platelet activation during carotid endarterectomy and the antiplatelet effect of Dextran 40
P A Robless1, T J Tegos, D Okonko
1Academic Surgical Unit, Imperial College School of Medicine, St Mary's Hospital, Praed St, London W2 1NY, UK.
Insights
Platelet activation increases during carotid endarterectomy (CEA). Dextran 40 demonstrated an antiplatelet effect post-CEA, potentially reducing thromboembolic complications.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Neurosurgery
Background:
- Carotid endarterectomy (CEA) involves significant surgical manipulation.
- Platelet activation and aggregation are critical in thromboembolic events.
- Current antiplatelet therapies may not fully prevent platelet activation during CEA.
Purpose of the Study:
- To investigate platelet activation markers during CEA.
- To evaluate the antiplatelet efficacy of Dextran 40 post-CEA.
Main Methods:
- Prospective study of 40 patients undergoing CEA.
- Platelet activity assessed via flow cytometry and aggregometry.
- P-selectin and PAC-1 used as activation markers; transcranial Doppler (TCD) monitored high-intensity transient signals (HITS).
Main Results:
- Carotid clamping and release significantly increased P-selectin and PAC-1 expression.
- Platelet aggregation increased post-clamping and release.
- HITS count elevated perioperatively; Dextran 40 infusion reduced P-selectin expression.
Conclusions:
- CEA triggers substantial platelet activation and aggregation.
- Dextran 40 exhibits antiplatelet properties following CEA.
- Dextran 40 may offer benefits in mitigating thromboembolic risks after CEA.
Objective:
To determine changes in platelet activation during carotid endarterectomy (CEA) and the antiplatelet effect of Dextran 40.
Methods:
Prospective study in 40 patients undergoing CEA. Platelet activity was measured by whole blood flow cytometry and platelet aggregometry during CEA. The expression of P-selectin and the PAC-1 antigen were used as markers of platelet activation and aggregation. Patients received aspirin (75-300 mg) preoperatively and 5,000 units unfractionated heparin during surgery. High intensity transient signals (HITS) in the ipsilateral middle cerebral artery were monitored using transcranial Doppler (TCD) perioperatively.
Results:
P-selectin expression increased after carotid clamping (P < 0.01) and clamp release (P < 0.05). There was higher expression of PAC-1 after carotid clamping (p < 0.05). Spontaneous and ADP-induced platelet aggregation increased after carotid clamping (P< 0.01) and release (P < 0.01). TCD monitoring showed an increased HITS count from preoperative levels, after clamp release (P < 0.01) and during recovery (P < 0.01). After the operation, patients with more than 50 HITS per 30 min were started on an infusion of dextran 40 (n = 6). P-selectin expression decreased 24 h after dextran 40 (P < 0.01).
Conclusion:
Significant platelet activation and aggregation occurs during CEA despite the current use of antiplatelet treatment. Dextran 40 had an antiplatelet effect after CEA providing further evidence that it may contribute to reducing thromboembolic complications.
