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How much coagulation therapy is needed for an Endarterectomy? Advised with aspirin. Is it safe?

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Vascular Surgeon
Practicing since : 2005
Answered : 8 Questions
Does one place a graft during an endarterectomy and how much coagulation therapy is needed. My moms neck felt really hard and stiff. Her new dr is stopping her coumadin and starting her on 325 mh of aspirin daily. Is this safe
Posted Mon, 28 May 2012 in Valvular Heart Disease
Answered by Dr. Srujal Shah 4 hours later
Hi Cynthiafesler,

I am a vascular & Endovascular surgeon. I routinely do endarterectomy and we daily deal with anticoagulation, grafts and antiplatelet drugs like aspirin. This is just for my brief introduction.

First of all, Endarterectomy is a surgical procedure where any blood vessel (precisely artery) is clamped on two sides, opened and the intraluminal blockade is removed manually by developing a plane between layers of artery. In short a segment of blood vessel is cleaned from within. Then it is washed nicely and repaired either directly or using a patch made up of a vein or a graft. Now studies and trials have proven that using patch for repair of endarterectomy gives wider patent lumen and better long term patency. This is because of addition of graft/vein patch will make the lumen area wider than original vessel. Only if the original vessel is too much dilated, surgeon may not use patch for closure and close the endarterecomised artery directly. I hope your first question is answered.
Coming to your second query. Anticoagulation during endarterectomy depends on patient’s body weight. Usually world wide unfractionated heparin is used during surgery and the universal dosage is 1 mg per kg of bodyweight which is again decided by anesthetist and surgeon during procedure depending on multiple factors. Again repeat dosages may be needed depending on duration of surgery.

Now coming to your mom's symptoms. Neck stiffness and hardness are not classical symptoms of stroke or transient ischemic attack. But there can be exceptional case like your mother where investigations like neck vessel doppler or CT scan can be helpful to confirm the clinical diagnosis following which surgeon may come on decision of carotid endarterectomy.

Now your last question. If your mother was already on coumadin , and she needs endarterectomy, your doctor will definitely switch over to either heparin or put her on aspirin. Because operating upon a patient who is on coumadin is fraught with risk of excessive bleeding as the effect last for about 3 to 5 days even after the drug is stopped. In contrast patient can be operated while on aspirin or Heparin as the effects are predictable and controllable. Only thing is aspirin takes 5 to 7 days for its full action to be established in human body. So I think your doctor's decision is right and safe.

Endarterectomy is time tasted and most frequently done operation for carotid arteries. Lots of research has been done on superiority of stenting versus endartercomy for carotid diseases. Surgical endarterecomy is of proven value in high volume centres and has less chances of perioperative stroke in expert hands.So i think you can discuss with your doctor about the results of his endarterecomies and go ahead with his decision.

I hope I have solved your queries satisfactorily. Still you have any doubts, please feel free to ask, I will be glad to help you. If you do not have any further questions you may close the discussion and rate my answer with a review.
I hope your mummy recovers very soon.

Kind regards,
Dr Srujal shah
Vascular & Endovascular surgeon.
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