The use of clopidogrel in carotid endarterectomy: an audit of current practice

Area of Science:

• Vascular Surgery
• Cardiology
• Pharmacology

Background:

• Clopidogrel is frequently used in patients undergoing carotid endarterectomy (CEA).
• Current clinical practice regarding its perioperative use is controversial.
• There is a lack of randomized controlled trial data to guide best practices.

Purpose of the Study:

• To investigate current clopidogrel prescribing habits among vascular surgeons performing CEA.
• To identify patterns of clopidogrel discontinuation or continuation around the time of CEA.
• To assess the use of alternative antiplatelet therapies.

Main Methods:

• A questionnaire survey was distributed to all members of the Vascular Society.
• The survey focused on clopidogrel usage patterns in the context of carotid endarterectomy.
• Data analysis explored the relationship between surgeon volume and prescribing habits.

Main Results:

• 52% of surgeons reported discontinuing clopidogrel preoperatively.
• Among those discontinuing, 51% did not use an alternative antiplatelet agent, while 49% switched to aspirin.
• Clopidogrel use was not associated with the number of CEAs performed per surgeon.

Conclusions:

• There is a significant lack of consensus regarding perioperative clopidogrel management for CEA.
• The findings underscore the need for prospective studies to establish evidence-based guidelines.
• Further research is required to optimize antiplatelet strategies in CEA patients.