IFT01 - Timing of Heparin Administration During Carotid Endarterectomy Affects Wound Hematoma Evacuation Rate

Friday, June 16, 2023

6:30 AM – 6:35 AM ET

Presenting Author only(s)

FF

Federico Furlan, MD (he/him/his)

Resident
Azienda Sanitaria Universitaria Friuli Centrale
Udine, Friuli-Venezia Giulia, Italy

Submitting Author only(s)

PS

Paola Scrivere

Vascular Surgeon
Azienda Sanitaria Universitaria Friuli Centrale
Udine, Friuli-Venezia Giulia, Italy

Senior Author(s)

PF

Paolo Frigatti

Italy

Co-Author(s)

MB

Maria Borrelli

Vascular Surgeon
Azienda Sanitaria Universitaria Friuli Centrale
Udine, Friuli-Venezia Giulia, Italy
AP

Andrea Piraino

Vascular Surgery Resident
Azienda Sanitaria Universitaria Friuli Centrale
Udine, Sicilia, Italy
TL

Tommaso Lazzarotto

San Giovanni di Dio Hospital - USL CENTRO
Florence, Italy
SM

Stefano Michelagnoli

San Giovanni di Dio Hospital - USL CENTRO
Florence, Toscana, Italy
Emiliano Chisci, MD

Vascular Surgeon
San Giovanni di Dio Hospital - USL CENTRO
Florence, Toscana, Italy

Objectives: To investigate whether timing of heparin administration during carotid endarterectomy (CEA) could affect postoperative outcomes.

Methods: Consecutive elective CEAs in two tertiary hospitals were enrolled for asymptomatic carotid stenosis ≥70% performed between 2011 and 2020. We grouped patients according to timing of heparin administration during CEA: (Group A) Heparin was given immediately before skin incision in the first group while in the second group (Group B) heparin was given two minutes before internal carotid artery clamping. Primary outcomes were 24-hour postoperative Major Adverse Events (MAEs: myocardial infarction, major and minor stroke, death), surgical site hematoma and wound hematoma evacuation rate. Secondary outcomes were 30-day MAEs and cranial nerves lesions rate.

Results: A total of 2167 patients underwent CEA: 1191 (55%) patients were treated in group A while 979 (45%) in group B with a similar mean operation time of 79 minutes. Weight-adjusted (70 IU/kg) heparin was administered in both groups. A higher number of patients under dual antiplatelet (7% vs. 15%) and anticoagulation (4.5% vs. 11%) therapy were recorded in group B due to the presence of a higher rate of coronary heart disease (P <.001). Eversion CEA was 89% and 56% in group A and B respectively. Protamine was administered in 3% vs. 90% of patients in group A and B respectively. Primary and secondary outcomes are summarized in Table I. After multivariate analysis, just wound hematoma evacuation rate was affected by the timing of heparin administration during CEA

Conclusions: The strategy of heparin administration before skin incision during CEA protects against wound hematoma evacuation without increasing the procedural risk .