Abstract WP147: Carotid Endarterectomy and Concurrent Clopidogrel Use: U.S. National Practice Patterns
Background: Patients diagnosed with high-grade carotid stenosis often receive a carotid endarterectomy (CEA) during their hospital stay and most receive antiplatelet medication. There is inter-surgeon variability in performing CEA in patients receiving clopidogrel due to its potent antiplatelet effect.
Methods: Utilizing the PREMIER database (a representative sample of 15% of US hospital discharges with procedure codes and medications); adults with principal discharge diagnosis coded as stroke, transient ischemic attack (TIA) or carotid artery stenosis or occlusion without stroke/TIA(CAS) (ICD-9: 434, 435, 433.10, and 433.11 respectively), who had a CEA (ICD-9 38.12) during the same hospital stay, in 2014 were analyzed. Clopidogrel use was defined as receiving any dose within the 3 days prior to the CEA. Univariate and multivariable analyses; T-test, Chi-square and multiple logistic regression, were used to examine the association of age, race, gender, principal diagnosis of stroke/TIA vs. CAO, academic vs non-academic center, and region of the US, with CEA following clopidogrel use.
Results: There were 15,381 patients with stroke, TIA, or CAS who had a CEA during the same hospital stay in 2014. Patients were median age 71 years, (IQR 65-78), 86% were Caucasians, 4% Black, and 10% other race; 42% were female. 2570 patients (17 %) received a dose of clopidogrel within 3 days prior to their procedures. In univariate analysis, male sex, having a stroke/TIA vs CAS, not being at a teaching hospital, being in the Northeast or South were associated with CEA after clopidogrel. Results for the multivariable analysis are presented in the Table.
Conclusions: Our study found that across the US, about 1 in 6 patients who undergo CEA have clopidogrel in their system. Younger age, having a stroke/TIA vs CAS, non-teaching hospitals, and areas other than the West are found to convey higher odds of CEA while on clopidogrel. Future analysis of differences in outcomes and safety events are needed.
Author Disclosures: E.A. Mistry: None. J. Khoury: None. D. Kleindorfer: None.
- © 2017 by American Heart Association, Inc.