[Per and early postoperative use of low molecular weight heparin in carotid surgery]

The goal of this study was to evaluate per and postoperative use of nadroparin during carotid surgery with mortality and neurologic morbidity as primary end points. From January 1995 to December 1999, 237 procedures were performed on 215 patients for isolated carotid surgery; 57% were symptomatic. Surgery was performed under general anesthesia. Before clamping, patients received an intravenous bolus of 70 UI/kg of nadroparin. Shunting was used in 40% of patients. Postoperatively, from the 6(th) hour, nadroparin was given subcutaneously, 2,850 UI or 3,800 UI every 12 hours depending on the patient weight (less or more than 70 kg). The only biologic surveillance was platelet count twice a week. Antiplatelet drugs were given at day 2. Completion Duplex scan was performed before day 30. Seven postoperative ischemic strokes (3 non disabling) occurred including one fatal stroke. Another patient died at day 25 from inaugural duodenal bleeding due to pancreas cancer. The 30 days stroke or death rate was 3.37% (5.92% in symptomatic; 0% in asymptomatic). No hemorrhagic stroke occurred. Four patients were reoperated for cervical hematoma (1.68%). No thrombocytopenia occurred. Duplex scan, performed on 235 operated carotid arteries, showed 2 asymptomatic carotid thromboses. No other cardiovascular complication was found on clinical data. These results are comparable to published literature data in prospective as well as retrospective studies. Per and postoperative use of nadroparin in carotid surgery gave results similar to previously published reports in terms of mortality, neurologic morbidity and hematoma. Its easy use, needing only 2 injections a day and platelet count, with a reduction of the risk of heparin-induced thrombocytopenia make the use of nadroparin very attractive during the perioperative period.