Perioperative use of aspirin for patients undergoing carotid endarterectomy

Background: This study was initiated to evaluate the cardiovascular benefit of perioperative use of acetylsalicyclic acid (ASA) in patients undergoing carotid surgery. Patients and methods: A prospective two-arm comparative study was conducted and focused on cardiac, neurological and bleeding complications for patients with high-grade (> 80 %) asymptotic or symptomatic (> 60 %), internal carotid artery stenosis based on NASCET criteria who were treated by surgery. Between March 2008 and November 2010, 540 patients underwent carotid endarterectomy in two European vascular centers. In particular, 267 consecutive patients (49.4 %) had taken perioperative ASA in one center; in 273 consecutive patients in the other center ASA administration was stopped 5 days preoperatively. Results: The overall complication rate was lower in the ASA group (5.2 % versus 17.6 %), p < 0.001, 95 %CI [2.1;7.2], OR 3.8. In detail, the myocardial event rate was lower in the ASA arm: 0.7 versus 4.4 % p = 0.012, OR 6.1 (95 % CI [1.4;27.45]. Concerning stroke, ASA patients benefit from oral antiaggregation as well: 1.5 vs. 5.5 %; p = 0.036). OR 4.5, 95 %CI [1.3;11.7], respectively. The bleeding complications were similar in both subgroups, 8 for the ASA group (3.0 %) and 10 (3.7 %) for the non-ASA group, p = 0.66. Multivariate logistic regression analysis showed significant benefit of mellitus and hypercholesterolemia, p < 0.001. Additionally, female patients of the ASA group also had significantly less overall (p=0.10, OR5.3), cardiac (p = 0.021, OR 3.6) and neurologic (p = 0.042, OR 6.7) complications. Bleeding risk was not higher in female patients receiving ASA (p = 0.25) Conclusions: Perioperative use of ASA patients undergoing carotid endarterectomy is associated with a lower risk of cardiac and neurological events without significant increase of postoperative bleeding necessitating revision.