Risk of Bleeding Complications With Different Peri Operative Antithrombotic Regimens During Carotid Endarterectomy: A National Registry Analysis

Risk of Bleeding Complications With Different Peri Operative Antithrombotic Regimens During Carotid Endarterectomy: A National Registry Analysis

1. Company name Risk of Bleeding Complications With Different Peri Operative Antithrombotic Regimens During Carotid Endarterectomy: A National Registry Analysis

2. Abstract

3. Abstract

4. Introduction Prevent by antithrombotic therapy  crucial role for prevention Thromboembolism Recommend considering early institution of DAPT after TIA or minor stroke to < risk of early recurrent ischemic ESVS 2023 guideline Thromboembolism originating from proximal source Ischaemic stroke DAPT < early risk of recurrent stroke Greatest benefit 21 days POINT and CHANCE

5. Introduction unresolved Optimal treatment strategy Higher bleed rates in patients on DAPT undergoing CEA compared SAPT Past studies Investigate the association of SAPT and DAPT with risk of bleeding complication after CEA Aim Paper

6. Methods DACI  registered with follow up 30 days since June 2013 Eligibility reviewed by multidisciplinary team in each 53 participating Data Source 01. Retrospective analysis  prospective collected data of DACI registry 17.884 patients Study population 02. No antithrombotic therapy unusual antithrombotic therapy combinations redo CEA was performed, patients were under the age of 40 years Exclusion criteria 03. DACI Registry Index event Peri Operative Anti thrombotic  SAPT including ASA and clopidogrel, and DAPT including ASA plus clopidogrel or ASA plus dipyridamole. Data collection 04.

7. Primary outcome  composite endpoint consisting of post-operative cervical bleeding Secondary outcome  ischaemic stroke or TIA and all cause mortality within the f irst 30 days following CEA Clinical outcome Them Baseline characteristic, primary and secondary outcomes compared between 5 antithrombotic regimens and ASA Baseline characteristics that showed an association of p < .20 with the determinant and outcome of interest (post-operative  considered as potential confounders for multivariable analyses Statistical Analysis Us Methods Lorem ipsum dolor sit amet , consectetur

8. Results Flowchart of included symptomatic and asymptomatic patients treated with primary carotid endarterectomy (CEA) from the Dutch Audit for Carotid Interventions (DACI) registry

9. Characteristic 12.317 symptomatic and asymptomatic patients at baseline

10. Operative clinical outcomes within 30 days after carotid endarterectomy in 12 317 symptomatic and asymptomatic patients with different antithrombotic regimens at baseline

11. Multivariable logistic regression analysis of different antithrombotic therapies in clinical outcomes within 30 days after carotid endarterectomy

12. risk of bleeding complications after CEA Study APT might safely be continued during the CEA peri operative period in patients high risk Results DAPT benefit to prevent recurrent stroke after acute minor ischaemic stroke or TIA Large RCTs Not mention benefit of DAPT over SAPT Treatment choice  depends on clinical preference Study Discussion

13. DAPT associated with an increased risk of reoperation for bleeding and neck haematoma after CEA vs. SAPT with aspirin. Quality  need more research 2022 meta analysis 117.973 patients  statistically significant higher rate of secondary bleeding complications requiring re-intervention without reducing the risk of ischaemic stroke German data study Early introduction  5 fold reduction in recurrent TIA prior to expedited CEA 4 fold reduction of spontaneous embolisation Prospective adult Discussion

14. Also be caused by occlusive, haemodynamic, or haemorrhagic pathways. Transcranial Doppler imaging carotid imaging haemodynamic event assessment Brain imaging DAPT with ASA plus dipyridamole was inversely associated with the risk of post-operative cervical bleeding Patients treated with anticoagulant therapy  increased risk of bleeding during surgical procedures, Drug therapy  risk of bleeding will be outweighed by the benefitofthe anticoagulant. 2014 ESC/ESA guidelines Future study Present study Peri operative stroke Discussion

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