Antiplatelet Treatment Prolongs Survival After Carotid Bifurcation Endarterectomy

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Abstract
To examine the role of antiplatelet drugs in the secondary prevention of arteriosclerotic arterial disease following carotid endarterectomy, a clinical series (n = 252) was analyzed. Based on the results a prospective randomized trial was initiated, comparing the effect of antiplatelet drugs (acetyl-salicylic acid [ASA] 1000 mg/day) versus untreated controls. In both investigations patient survval was the primary end point. A cardiac risk (n = 91) implied a significant reduction in patient survival (p < 0.019 Breslow, p < 0.052 Mantel). Antiaggregating drugs prolonged survival in the collective series (p < 0.0001 Breslow, p < 0.0002 Mantel) and in the subgroup of patients with cardiac risk (p < 0.014 Breslow, p < 0.020 Mantel) as well. In the prospective trial 66 patients were recruited, receiving ASA (n = 32) versus no therapy (n = 34). During follow-up 15 patients died, 4 in the treatment, and 11 in the control group. Between both groups there was a significant difference in the probability of survival (p < 0.021 Breslow, p < 0.048 Mantel).