(Press-News.org) Despite the common clinical practice among surgeons to discontinue their patients' anti-platelet therapy prior to surgery, a recent study of patients undergoing carotid endarterectomy (CEA) indicated that this practice may be unnecessary. The study will be published in the December issue of the Annals of Vascular Surgery.
The use of clopidogrel (Plavix, Bristol-Myers Squibb/Sanofi-Aventis), an antiplatelet agent prescribed for patients with acute myocardial infarction (severe heart attack), recent stroke or peripheral arterial disease, continues to rise with U.S. sales of $3.9 billion in 2007, wrote the authors. As a result, the researchers sought to examine outcomes related to antiplatelet therapy in patients undergoing CEA, which is a surgical procedure that removes plaque from the carotid arteries in the neck to prevent stroke.
"Most surgeons choose to discontinue their patients' use of anti-platelets prior to surgery, despite the lack of scientific evidence," said study author Adnan Z. Rizvi, MD, from the department of vascular and endovascular surgery at the Minneapolis Heart Institute® at Abbott Northwestern Hospital in Minneapolis. "However, studies have found increased bleeding with patients taking Plavix during open-heart surgery, so this surgery is an exception to our findings."
"In our practice, we previously stopped Plavix use prior to CEA. Yet, more recently, we have allowed some of our patients to continue with their anti-platelet therapy before undergoing CEA," explained Rizvi. "We decided to undertake this study to assess whether there were any higher bleeding complications associated with this decision."
For the study, five board-certified vascular surgeons retrospectively analyzed 260 consecutive patients who underwent CEA at the Minneapolis Heart Institute® performed by between June 2006 and April 2009. Fifty of these patients were taking clopidogrel during surgery, were compared with nine patients who had their clopidogrel discontinued prior to surgery.
The technique selected for CEA was at the discretion of the operating surgeon, and included endarterectomy with a patch (Dacron, bovine pericardium or vein), angioplasty or eversion endarterectomy.
The researchers found that the patients who were on clopidogrel had a longer operative time as compared with those who were on aspirin alone; however, operative blood loss was not statistically different. Interestingly, most of the bleeding complications that occurred in patients who were on clopidogrel occurred in patients who underwent endarterectomy with a Dacron patch angioplasty.
Based on their findings, Rizvi and colleagues concluded that carotid surgery can be safely performed on patients taking clopidogrel, but there is a higher risk of bleeding complications associated with using a Dacron patch. "However, if other techniques, such as eversion or bovine pericardium patch are used, then there is no different in bleeding complications with patients taking clopidogrel," Rizvi said.
"With the exception of open-heart surgery, we suspect our findings can be translated for other surgeries, but a larger randomized study is warranted to support these conclusions," he concluded.
###
Minneapolis Heart Institute®
The Minneapolis Heart Institute® is recognized internationally as one of the world's leading providers of heart and vascular care. This state-of-the-art facility combines the finest in personalized patient care with sophisticated technology in a unique, family-oriented environment. The Institute's programs, a number of which are conducted in conjunction with Abbott Northwestern Hospital, address the full range of heart and vascular health needs: prevention, diagnosis, treatment and rehabilitation.
Minneapolis Heart Institute Foundation
The Minneapolis Heart Institute Foundation is dedicated to creating a world without heart disease through groundbreaking clinical research and innovative education programs. MHIF's mission is to promote and improve cardiovascular health, quality of life and longevity for all.
Whatever its final incarnation, the recently enacted landmark Patient Protection and Affordable Care Act will expand Medicaid eligibility and is expected by 2013 to provide coverage, including mental health care, to an estimated 4.1 million children currently uninsured.
That's a good thing. But what will the quality of care be, especially for vulnerable children with special health care needs? Poor, according to a new report in the current online edition of the Journal of the American Academy of Child and Adolescent Psychiatry.
In cooperation with LA Care, one of ...
SAN ANTONIO, TEX. (December 9, 2010)––Nearly one-fifth of all metastatic breast cancer patients develop brain metastases and have significantly shorter overall survival than patients who do not have brain involvement. One way to improve the affected patients' survival might be to prevent the brain metastases from arising in the first place. With that in mind, researchers have been working on a predictive model that accurately identifies these high risk patients. Now, Veeraiah Siripurapu, M.D., and colleagues from Fox Chase Cancer Center have verified several factors––including ...
Despite their initial focus on national economic competitiveness, the nanotechnology research initiatives now funded by more than 60 countries have become increasingly collaborative, with nearly a quarter of all papers co-authored by researchers across borders.
Researchers from the two leading producers of nanotechnology papers – China and the United States – have become each nation's most frequent international co-authors. Though Chinese and U.S. researchers now publish roughly the same number of nanotechnology papers, the U.S. retains a lead in the quality of publications ...
A novel strategy of blocking the growth of blood vessels with antibodies should result in improved treatment of cancerous tumors.
The growth of new blood vessels from pre-existing vasculature is called angiogenesis. In adults, angiogenesis occurs only during wound healing and menstrual cycling, but is abundant and harmful in cancerous tumors and the old-age eye disease frequently leading to blindness called age-related macular degeneration (AMD). Without the formation of new blood vessels, tumors cannot grow beyond a small size due to lack of oxygen and nutrients. Inhibition ...
(Washington) – The American College of Physicians (ACP) today commended Congress for taking bipartisan action to preserve access for patients enrolled in Medicare and TriCare by stabilizing physician payments through 2011. The College noted, though, that the incoming 112th Congress will need to enact legislation to provide longer-term stability in payments and lead to repeal of the Sustainable Growth Rate (SGR) formula.
The legislation, passed unanimously by the Senate yesterday and passed by an overwhelming majority in the House of Representatives today, will avert ...
ANN ARBOR, Mich.---A wave of reptile extinctions on the Greek islands over the past 15,000 years may offer a preview of the way plants and animals will respond as the world rapidly warms due to human-caused climate change, according to a University of Michigan ecologist and his colleagues.
The Greek island extinctions also highlight the critical importance of preserving habitat corridors that will enable plants and animals to migrate in response to climate change, thereby maximizing their chances of survival.
As the climate warmed at the tail end of the last ice age, ...
CINCINNATI—Researchers at the University of Cincinnati (UC) and Massachusetts General Hospital have found that warfarin, a known anticoagulation (blood-thinning) drug, may not be as beneficial to some patients with atrial fibrillation as previously thought.
These findings were published online this week ahead of print in the journal Circulation: Cardiovascular Quality and Outcomes.
Warfarin is commonly prescribed to prevent blood clotting, particularly for patients with atrial fibrillation—a type of abnormal heart rhythm.
Mark Eckman, MD, professor of medicine at ...
Alzheimer and heart attacks have been found to share common genetic basis. The research leads the way to the first genetic test on developing the risk of the diseases even at a young age. According to Federico Licastro, an immunologist at the University of Bologna who coordinated the study published in the scientific journal, Journal of Alzheimer's Disease, a test is now ready. "They are already selling it in America", he says, citing the case of a private firm in New Mexico (USA) that collaborated on the study. "But the tests could easily be also conducted wherever, using ...
(Santa Barbara, Calif.) –– Remarkable progress in understanding how stem cell biology works has been reported by a team of leading scientists, directed by experts at UC Santa Barbara. Their research has been published in the journal Cell Stem Cell.
Stem cell biology is making waves around the world with great hope for the eventual repair of parts of the body. While many scientists see these breakthroughs as viable, there are hurdles that must be overcome, including the worrisome potential for introducing cancer when making a repair to an organ.
Significant interdisciplinary ...
Scientists at the Virginia Bioinformatics Institute at Virginia Tech have discovered some of the key molecular events in the immune system that contribute to inflammatory bowel disease. The results, which help researchers move one step further in their efforts to develop new drugs to treat inflammatory and immune-mediated diseases, are reported in the November 2010 edition (http://www.ncbi.nlm.nih.gov/pubmed/21068720) of the journal Mucosal Immunology from the Nature Publishing Group.
Inflammatory bowel disease starts when the gut initiates an abnormal immune response ...