Assadian A, Eidher U, Senekowitsch C, Rotter R, Löchli S, Hagmüller G W, Knöbl P
Department of General and Vascular Surgery, Wilhelminenspital Vienna, Austria.
Vasa. 2006 May;35(2):96-100. doi: 10.1024/0301-1526.35.2.96.
Antiplatelet therapy is one of the most important modalities for secondary prevention of ischemic events. The aim of this prospective study was to evaluate the current practice of antiplatelet therapy in patients with high grade stenosis of the internal carotid artery (ICA), who were referred by neurologists, stroke physicians and cardiologists for carotid endarterectomy.
Patients referred to our department for carotid endarterectomy with ICA stenosis (> 70% according to NASCET criteria) were prospectively evaluated regarding atherosclerosis risk factors and current antiplatelet therapy. During a 7 month period, 235 patients were scheduled for carotid endarterectomy. Their mean age was 70 years (range 42 years to 95 years), 91 patients were female (39%), 144 male (61%). 122 patients (52%) had a symptomatic ICA stenosis, 113 (48%) an asymptomatic ICA stenosis.
Of the 235 patients, 29 were either on low molecular weight heparin or vitamin K antagonists for reasons other than ICA stenosis and were therefore excluded from analysis. Therefore, 206 patients (88%) were evaluated for antiplatelet therapy prescribed by their admitting physicians. Of these patients, 77 (37%) (42 (41%) symptomatic and 35 (34%) asymptomatic patients) did not receive any antithrombotic therapy prior to admission for surgery. The majority of patients received aspirin preoperatively (106 patients, 51.5%) 13 (6%) patients were on clopidogrel and 10 (5%) on dual therapy with Aspirin and clopidogrel.
More than one third of patients awaiting carotid endarterectomy did not receive any antiplatelet therapy, despite high grade ICA stenosis. Since this practice does not meet the current guidelines, campaigns to increase the awareness of this problem are urgently needed.
抗血小板治疗是缺血性事件二级预防的最重要方式之一。这项前瞻性研究的目的是评估由神经科医生、中风科医生和心脏病科医生转诊来进行颈动脉内膜切除术的颈内动脉（ICA）高度狭窄患者的抗血小板治疗现状。
前瞻性评估转诊至我科进行ICA狭窄（根据北美症状性颈动脉内膜切除术试验协作组（NASCET）标准>70%）颈动脉内膜切除术的患者的动脉粥样硬化危险因素及当前抗血小板治疗情况。在7个月期间，235例患者计划进行颈动脉内膜切除术。他们的平均年龄为70岁（范围42岁至95岁），91例为女性（39%），144例为男性（61%）。122例患者（52%）有症状性ICA狭窄，113例（48%）有无症状性ICA狭窄。
235例患者中，29例因ICA狭窄以外的原因使用低分子量肝素或维生素K拮抗剂，因此被排除在分析之外。因此，对206例患者（88%）进行了其主治医生开具的抗血小板治疗评估。在这些患者中，77例（37%）（42例（41%）有症状患者和35例（34%）无症状患者）在手术入院前未接受任何抗血栓治疗。大多数患者术前接受阿司匹林治疗（106例患者，51.5%），13例（6%）患者使用氯吡格雷，10例（5%）患者接受阿司匹林和氯吡格雷双联治疗。
尽管ICA高度狭窄，但超过三分之一等待颈动脉内膜切除术的患者未接受任何抗血小板治疗。由于这种做法不符合当前指南，迫切需要开展提高对此问题认识的活动。
