颈动脉内膜剥脱术围手术期的抗凝和抗血小板治疗

Perioperative anticoagulation or antiplatelet therapy in cases of carotid endoarterectomy

目的 评价颈动脉内膜剥脱术围手术期间抗凝治疗和抗血小板治疗的有效性和安全性.方法 回顾性分析北京协和医院血管外科中心2004年1月到2008年12月期间的110例（122例次）患者行颈动脉内膜剥脱术治疗的临床资料.根据围手术期间用药情况,将122例次颈动脉内膜剥脱术分为抗凝治疗和抗血小板治疗2组.比较两组术后脑卒中/死亡事件和伤口血肿的发生率.结果 122例次中抗凝治疗组45例次,抗血小板治疗组77例次.围手术期间3例（2.6%）发生脑卒中,其中抗凝治疗组1例（2.2%）,抗血小板治疗组2例（2.6%）（P=0.897）.两组均无死亡病例（P=1.00）.术后7例（5.7%）发生伤口血肿,其中抗凝治疗组6例（13.3%）,抗血小板治疗组1例（1.3%）,两组差异有统计学意义（P=0.006）.结论 颈动脉内膜剥脱术围手术期间单独应用抗血小板药物安全有效,不会增加围手术期间卒中/死亡率,而术后应用抗凝药物则会增加伤口血肿发生率.

Objective To evaluate the efficacy and safety of perioperative anticoagulation and antiplatelet therapy of carotid endoarterectomy （CEA）. Methods A retrospective study on 110 cases （122 CEAs） of carotid stenosis between Jan 2004 and Dec 2008 was undertaken. 122 cases were divided into anticoagulation group and antiplatelet group according to the perioperative medical treatment. Postoperative results of stroke/death and wound hemotoma were compared between the two groups and statistically analyzed. Results 45 CEAs were given perioperative combination of anticoagulation and antiplatelet treatment. This comprised the anticoagulation group. The antiplatelet group consisted of the other 77 CEAs which were treated with antiplatelet solely. Perioperative stroke/death rates were equivalent （2.2% anticoagulation vs. 2.6% antiplatelet, P =0.897）. Wound hemotoma rates were found with statistical significant difference between the two groups （13.3% anticoagulation group vs. 1.3% antiplatelet group, P = 0. 006 ）. Conclusion Our results suggest that perioperative antiplatelet therapy in perioperative carotid endoarterectomy does not increase perioperative stroke/death risk, while perioperative anticoagulation increases the risk of wound hematoma.