Discontinuation of antiplatelet therapy for postoperative bleeding in carotid endarterectomy patients: a meta-analysis / 临床麻醉学杂志

ABSTRACT

Objective To systematically review the effect of discontinuation of antiplatelet therapy for postoperative bleeding in carotid endarterectomy(CEA) patients by meta-analysis.Methods We searched the PubMed, Embase, Cochrane library, CNKI, China Biology Medicine (CBM), Wanfang Database and VIP, and collected all the randomized controlled trials (RCTs) about this topic.The quality of the included studies was evaluated using the method recommended by Cochrane Collaboration.Meta-analysis was conducted using RevMan 5.3 software.Results Four RCTs involving 514 patients were included, 256 in the control group and 258 in the intervention group.All outcome measures were not heterogeneous (P>0.1, I2<50%), fixed effect model was used to analyze the outcomes.The results of meta-analysis showed that discontinuation of preoperative antiplatelet therapy could significantly reduce the risk ratio of postoperative stroke (RR=0.30, 95%CI 0.11-0.83, P=0.02).There was no significant difference in the risk of 30 d (RR=0.23, 95%CI 0.04-1.32, P=0.1) and 1-year mortality (RR=0.49, 95%CI 0.24-1.02, P=0.06), postoperative major bleeding (RR=1.40, 95%CI 0.54-3.59, P=0.49), postoperative bleeding complications (RR=1.02, 95%CI 0.15-6.96, P=0.98) and TIA (RR=1.08, 95%CI 0.47-2.49,P=0.86) between the two groups.Conclusion Discontinuation of preoperative aspirin therapy could significantly reduce the rate of postoperative stroke without increasing bleeding risk.