Abstract WP075: Antithrombotic Management Before Carotid Endarterectomy in Recently Symptomatic Patients

BACKGROUND: There is limited evidence and few recommendations in best practice guidelines regarding the optimal antithrombotic strategy prior to carotid endarterectomy (CEA) in patients with recently symptomatic carotid disease. We examined current practices at a large Canadian tertiary stroke center. METHODS: Patients undergoing CEA for symptomatic carotid stenosis between 2018–2022 were identified through hospital administrative data using procedural codes. Chart review was performed to confirm transient ischemic attack (TIA) or ischemic stroke within 2 weeks of surgery. We compared patient demographics, comorbidities, recurrent ischemic and bleeding events, and post-surgical complications across pre-procedure antithrombotic strategies, applying Bonferroni correction for multiple testing. RESULTS: We identified 217 patients who underwent CEA within 2 weeks of symptom onset due to carotid stenosis >50%. Nearly all (98.2%) were on antithrombotic therapy prior to surgery: 21% on single antiplatelet therapy, 15% on dual antiplatelet therapy, 2.3% on anticoagulation alone, and 59% on combined anticoagulation and antiplatelet therapy. There were no significant differences in age, sex, time from symptom onset to admission, or degree of stenosis across treatment groups. Atrial fibrillation was more frequent among patients on anticoagulation (alone or in combination) compared with those on antiplatelets alone. No periprocedural deaths occurred. The overall rate of recurrent cerebral ischemic events before CEA was 5.5%, bleeding complications (including pre- and post-procedure) occurred in 1.8%, perioperative myocardial infarction in 0.5%, and periprocedural stroke in 3.7%, with no significant differences between antithrombotic strategies (Table 1). CONCLUSIONS: We observed substantial variation in antithrombotic strategies prior to CEA, without significant differences in rates of recurrent ischemic events, bleeding, or perioperative complications.