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Anticoagulation strategy in patients with atrial fibrillation after carotid endarterectomy

Murat Ugurlucan1, Hakki Tankut Akay2, Ibrahim Erdinc3

  • 1a Department of Cardiovascular Surgery , Istanbul University Istanbul Medical Faculty , Istanbul , Turkey.

Acta Chirurgica Belgica
|September 8, 2018
PubMed

Insights

This study suggests that combining warfarin (targeting INR 2-3) with aspirin (100mg daily) is a feasible anticoagulation strategy for patients with atrial fibrillation after carotid endarterectomy. Further multicenter research is needed for definitive protocols.

Area of Science:

  • Cardiology
  • Vascular Surgery
  • Geriatrics

Background:

  • Carotid artery stenosis and atrial fibrillation are prevalent conditions in aging populations.
  • Optimal anticoagulation protocols for patients with atrial fibrillation undergoing carotid endarterectomy are not well-established.
  • This study addresses the need for evidence-based anticoagulation strategies in this specific patient group.

Purpose of the Study:

  • To evaluate the feasibility and outcomes of a combined anticoagulation strategy (warfarin and aspirin) in patients with atrial fibrillation following carotid endarterectomy.
  • To present clinical experiences and patient data from a cohort undergoing this specific treatment regimen.

Main Methods:

  • Retrospective review of 165 patients with atrial fibrillation who underwent carotid endarterectomy and received warfarin and aspirin between June 2001 and September 2017.
  • Data collected from three institutions, including patient demographics, comorbidities (diabetes, hypertension), and follow-up duration (mean 64.4 months).
  • Warfarin dosage aimed for an International Normalized Ratio (INR) of 2-3, with aspirin at 100mg daily.

Main Results:

  • Early mortality observed in two patients (intracranial bleeding, heart failure).
  • Late mortality included one patient due to intracerebral hemorrhage and 16 due to other causes.
  • Three patients required surgical exploration due to bleeding complications.

Conclusions:

  • The combination of warfarin (INR 2-3) and aspirin (100mg) appears to be a feasible anticoagulation approach for patients with atrial fibrillation post-carotid endarterectomy in this cohort.
  • Larger, multicenter studies are warranted to establish precise and definitive anticoagulation treatment protocols for this patient population.

Keywords:
Carotid endarterectomyanticoagulationatrial fibrillation

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