[Carotid Endarterectomy in Patients with Antiaggregation Therapy]

Area of Science:

• Vascular Surgery
• Surgical Hemostasis
• Cardiovascular Disease Management

Background:

• Carotid endarterectomy is a common surgical treatment for atherosclerosis-induced extracranial carotid artery disease.
• Postoperative bleeding is a significant complication, occurring in up to 8% of cases, sometimes requiring reoperation.
• Patients often receive heparin and antiplatelet therapy, increasing bleeding risk.

Purpose of the Study:

• To evaluate the efficacy of TachoSil as a topical hemostatic agent during carotid endarterectomy.
• To determine if TachoSil prevents minor bleeding without causing local inflammation or infection.
• To assess the safety and effectiveness of TachoSil in patients undergoing carotid surgery on antiplatelet therapy.

Main Methods:

• A prospective series of 24 consecutive patients with extracranial carotid artery stenosis undergoing surgery.
• Patients maintained antiplatelet therapy (aspirin and/or clopidogrel) until the day before surgery.
• TachoSil sponges were applied topically during carotid endarterectomy to manage bleeding.

Main Results:

• None of the 24 patients experienced postoperative wound infection after TachoSil application.
• TachoSil effectively managed bleeding, with only six patients requiring additional sutures after initial application.
• No local signs of inflammation or infection were observed in patients treated with TachoSil.

Conclusions:

• Intraoperative topical application of TachoSil is a safe and effective method to reduce bleeding complications in carotid endarterectomy.
• TachoSil does not increase the incidence of postoperative wound infection or inflammation.
• TachoSil represents a valuable adjunct for hemostasis in complex vascular surgeries, particularly in patients on antiplatelet therapy.