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(Stroke. 2004;35:1227.)
© 2004 American Heart Association, Inc.

Cochrane Corner

Antiplatelet Therapy for Preventing Stroke and Other Vascular Events After Carotid Endarterectomy

From Neurological Clinic and Stroke Unit, University Hospital Basel, Switzerland.

Correspondence to Dr Philippe Lyrer, Neurological Clinic and Stroke Unit, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland. E-mail plyrer@uhbs.ch

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Antiplatelet drugs are effective and safe in a wide variety of patients at high risk for vascular ischemic events. Among patients undergoing vascular surgical procedures, these agents significantly reduce the risk of graft or native vessel occlusion. In this context, we examined their effects in patients after carotid endarterectomy (CEA).

Objectives

The objective of this review was to evaluate whether antiplatelet agents are safe and beneficial after endarterectomy of the internal carotid artery.

Search Strategy

We searched the Cochrane Stroke Group Trials Register (last search October 1, 2002). In addition, we performed comprehensive searches of the Cochrane Controlled Trials Register (Cochrane Library Issue 3, 2002), MEDLINE (January 1966 to September 2002), and EMBASE (January 1980 to September 2002), and we checked all relevant articles for additional eligible studies.

Selection Criteria

We selected randomized, controlled, unconfounded trials (RCTs) comparing antiplatelet agents with control after carotid endarterectomy in symptomatic or asymptomatic carotid stenosis of different degrees. Treatment duration had to be at least 30 days after CEA. Follow-up should be at least 3 months.

Data Collection and Analysis

Two reviewers selected trials for inclusion, assessed trial quality, and extracted data independently from each other. From each trial, we extracted the number of patients originally allocated to each treatment group and the number of patients who met the criteria for each outcome (intention-to-treat analysis). We calculated a weighted estimate of the odds for each outcome event across studies using the Peto OR (OR) method.

Main Results

Six trials involving 907 patients were identified. For death (all causes), the Peto OR of 0.77 with a . . . [Full Text of this Article]