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.