Intervention Review

Antiplatelet therapy for preventing stroke and other vascular events after carotid endarterectomy

  1. Stefan Engelter,
  2. Philippe Lyrer*

Editorial Group: Cochrane Stroke Group

Published Online: 21 JUL 2003

Assessed as up-to-date: 31 MAR 2003

DOI: 10.1002/14651858.CD001458


How to Cite

Engelter S, Lyrer P. Antiplatelet therapy for preventing stroke and other vascular events after carotid endarterectomy. Cochrane Database of Systematic Reviews 2003, Issue 3. Art. No.: CD001458. DOI: 10.1002/14651858.CD001458.

Author Information

  1. University Hospital Basel, Department of Neurology, Basel, Switzerland

*Philippe Lyrer, Department of Neurology, University Hospital Basel, Petersgraben 4, Basel, 4031, Switzerland. plyrer@uhbs.ch.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JUL 2003

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Antiplatelet drugs are effective and safe in a wide variety of patients at high risk of vascular ischaemic events. Among patients undergoing vascular surgical procedures, these agents significantly reduce the risk of graft or native vessel occlusion. In this context we wished to examine their effects in patients after carotid endarterectomy (CEA).

Objectives

To evaluate whether antiplatelet agents are safe and beneficial after endarterectomy of the internal carotid artery.

Search methods

We searched the Cochrane Stroke Group Trials Register (last searched 1 October 2002). In addition we performed comprehensive searches of the Cochrane Controlled Trials Register (The Cochrane Library Issue 3, 2002), MEDLINE (January 1966 to September 2002) and EMBASE (January 1980 to September 2002), and checked all relevant papers for additional eligible studies.

Selection criteria

We selected randomised, controlled, unconfounded trials comparing antiplatelet agents with control after carotid endarterectomy in symptomatic or asymptomatic carotid stenosis of different degrees. Treatment duration had to be at least 30 days after CEA. Follow up should be at least three months.

Data collection and analysis

Two review authors selected trials for inclusion, assessed trial quality, and extracted data independently from each other. From each trial we extracted the number of patients originally allocated to each treatment group, and the number of patients who met the criteria for each outcome (intention-to-treat analysis). We calculated a weighted estimate of the odds for each outcome event across studies using the Peto odds ratio method.

Main results

Six trials involving 907 patients were identified. For 'death (all causes)' the Peto odds ratio of 0.77 with a 95% confidence interval (CI) of 0.48 to 1.24 did not show a statistically significant difference between both treatment groups. For 'stroke (any)' the Peto odds ratio of 0.58 (95% CI: 0.34 to 0.98) indicated a statistically significant benefit in favour of antiplatelet drugs (P = 0.04). For 'vascular death', 'stroke or vascular death', 'serious vascular events', 'death or dependency', 'myocardial infarction', 'major extracranial haemorrhage', 'local haemorrhage requiring surgery', 'restenosis', 'TIA or amaurosis fugax', neither any benefit nor any hazard of antiplatelet drugs could be shown. For the outcome events 'intracranial haemorrhage', 'ischaemic stroke' and 'occurrence or progression of contralateral stenosis', data were either too sparse for meaningful analyses, or not available at all.

Authors' conclusions

Our results may indicate that antiplatelet drugs did not significantly change the odds of death but reduce the outcome 'stroke of any cause' in patients undergoing carotid endarterectomy. However, it can not be excluded that the beneficial effect in reducing stroke is due to chance. There is a suggestion that antiplatelets may increase the odds of haemorrhage, but there are currently too few data to quantify this effect.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Antiplatelet therapy for preventing stroke and other vascular events after carotid endarterectomy

Patients with narrowing of one of the major blood vessels to the brain, the internal carotid artery, are at risk of stroke. The surgical operation to remove the narrowing (carotid endarterectomy) can reduce the long-term risk of stroke. Drugs such as aspirin which prevent blood platelets forming clots (antiplatelet drugs) can also reduce the risk of stroke, but can sometimes cause serious bleeding. This review showed that antiplatelet drugs can also reduce the risk of stroke in patients undergoing carotid endarterectomy. There was limited information on bleeding risk. The review's conclusions supported the routine use of antiplatelet drugs such as aspirin in patients having carotid endarterectomy.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

使用抗血小板藥物用於頸動脈內膜切除術後的病人以預防二次中風或其他血管疾病

抗血小板藥物對於有缺血性疾病高風險的病人是有效且安全的. 抗血小板藥物能有效降低進行血管手術的病人其移植或原血管的阻塞. 在本文中,希望能檢視抗血小板藥物在接受頸動脈內膜切除術後病人的效用.

目標

本回顧的目標在於評估抗血小板藥物用在接受頸動脈內膜切除術後病人的效用及安全性.

搜尋策略

我們搜尋了Cochrane Stroke Group Trials Register(搜尋至2002年10月1日). 此外,也廣泛地搜尋了Cochrane Controlled Trials Register (Cochrane Library Issue 3, 2002年), MEDLINE (1966年1月至2002年9月) and EMBASE (1980年1月至 2002年9月),也檢視了所有其他相關的文獻.

選擇標準

我們選擇了比較抗血小板藥物在接受頸動脈內膜切除術後病人(不同程度的狹窄或無症狀的頸動脈狹窄)隨機分配無偏差的試驗. 治療期需至少需頸動脈內膜切除術後30天. 追蹤期需至少3個月.

資料收集與分析

2位回顧者獨立地選入試驗,評估試驗品質及摘錄數據. 我們摘錄每個試驗進入實驗組的病人數並依照intentiontotreat analysis來分析結果. 我們使用了Peto odds ratio method來計算每一種結果的加權後的可能性.

主要結論

6個包含907人的試驗被選取. 對於全死亡率,實驗組和對照組並無明顯差異(Peto odds ratio of 0.77 with a 95% confidence interval (CI) of 0.48 – 1.24). 對於中風,結果顯示使用抗血小板藥物有明顯差異(Peto odds ratio of 0.58 (95%CI: 0.34 – 0.98)(p = 0.04). 關於次要結果,如血管相關死亡,中風或血管相關死亡,嚴重血管事件,死亡或殘障,心肌梗塞,重大顱外出血,局部需手術的出血,血管再阻塞,暫時性腦缺血或暫時性黑矇,使用抗血小板藥物並無明顯好處或有害. 至於顱內出血,缺血性中風和對側血管阻塞的發生或持續,則因資料的不足或缺乏而無法得到結論.

作者結論

結果顯示,使用抗血小板藥物在頸動脈內膜切除術後的病人,並不能有效降低死亡率,但是對於降低中風再發生率是有幫助的. 但是,降低中風再發生率並不能完全歸功於抗血小板藥物. 也有研究顯示,抗血小板藥物可能會造成出血機率上升,但目前尚無足夠證據來證實.

翻譯人

本摘要由奇美醫院何乘彰翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

抗血小板藥物能避免頸動脈手術後的中風. 供應病人大腦的主要血管中若有一狹窄,像是內頸動脈,是中風的危險因子。用外科手術去除狹窄(頸動脈內膜切除術),可以減少後續中風的風險。如阿司匹林等藥物來防止血小板形成血栓(抗血小板藥物),也可以減少中風的危險,但有時會導致嚴重的出血。這篇文獻回顧顯示,抗血小板藥物也可以減少接受頸動脈內膜切除術病人中風的風險。出血的危險則受限於有限的資料。這篇文獻回顧的結論支持了常規使用抗血小板藥物如阿司匹林用於有接受頸動脈內膜切除的患者。