Dextran as an Adjunct in Carotid Endarterectomy: A Systematic Review and Meta-Analysis
Duarte Silva-Vieira1, António Pereira-Neves2, Hipolito Nzwalo3
1Faculty of Medicine of the University of Porto, Porto, Portugal.
Insights
Dextran use in carotid endarterectomy (CEA) showed a low stroke incidence (0.7%) post-surgery. Further trials are needed to confirm efficacy and safety due to study heterogeneity and potential risks.
Area of Science:
- Vascular Surgery
- Pharmacology
- Evidence-Based Medicine
Background:
- Carotid endarterectomy (CEA) is a key stroke prevention surgery for carotid artery stenosis.
- Dextran, an antithrombotic agent, is explored for reducing complications during CEA.
- Its efficacy and safety in this context remain debated.
Purpose of the Study:
- To systematically review and meta-analyze the incidence of thromboembolic and hemorrhagic complications.
- To assess the safety and efficacy of dextran as an adjunctive therapy in CEA patients.
Main Methods:
- Systematic literature search across major databases (MEDLINE, Scopus, Web of Science).
- Random-effects meta-analysis to pool adverse event incidence.
- Quality assessment using NHLBI and Cochrane tools; heterogeneity assessed via meta-regression.
Main Results:
- Ten studies (149,540 patients) were included; predominantly observational with one RCT.
- Pooled incidence of stroke post-CEA with dextran was 0.7% (95% CI: 0.3-1.1%), showing moderate heterogeneity.
- Geographic region was a significant source of heterogeneity; dextran often used selectively in high-risk patients.
Conclusions:
- Dextran use in CEA is linked to a low incidence of thromboembolic events.
- Heterogeneity necessitates further large-scale RCTs for definitive efficacy and safety data.
- Individualized patient selection and standardized protocols are crucial due to potential risks like hemorrhage and renal issues.
Background:
Carotid endarterectomy (CEA) is a widely used surgical procedure to prevent stroke in patients with carotid artery stenosis. Dextran, an antithrombotic agent with antihemostatic properties, has been proposed as an adjunctive therapy to reduce thromboembolic complications during CEA. However, its effectiveness and safety remain controversial. This systematic review and meta-analysis aim to assess the incidence of thromboembolic and hemorrhagic complications in patients undergoing CEA with dextran administration.
Methods:
A systematic search was conducted in MEDLINE, Scopus, and Web of Science for studies evaluating the postoperative effects of dextran in CEA patients. Random-effects meta-analysis was performed to estimate the pooled incidence of adverse events, and heterogeneity was assessed through meta-regression analysis. The quality of the included studies was evaluated using the National Heart, Lung, and Blood Institute Study Quality Assessment Tool for observational studies and the Cochrane Risk-of-Bias 2 tool for randomized controlled trials (RCTs).
Results:
Ten studies, including a total of 149,540 patients, met the inclusion criteria. Of these, 9 were observational cohort studies (6 retrospective and 3 prospective), while one was an RCT. The meta-analytical incidence of stroke following CEA with dextran was 0.7% at 30 days post operatively (95% confidence interval, 0.3-1.1%), with moderate heterogeneity (I2 = 50.79%, P = 0.002). Meta-regression analysis indicated that geographic region significantly contributed to heterogeneity (P = 0.010), while other clinical covariates, such as diabetes, hypertension, and coronary artery disease, were not associated with significant variations in outcomes. Dextran was primarily administered selectively to high-risk patients, with variations in dosing protocols across studies.
Conclusion:
The use of dextran in CEA was associated with a low incidence of thromboembolic events. However, some heterogeneity among studies highlights the need for further large-scale RCTs to clarify its efficacy and safety. Given the potential risks of dextran, including hemorrhage and renal complications, individualized patient selection and standardized administration protocols are recommended.
