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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Giornale Italiano di Chirurgia Vascolare 1999 September;6(3):161-79
language: English, Italian
Pharmacological therapy after carotid endarterectomy: heparin, sulodexide, ticlopidine
Stella A., Tarantini S. *, Palareti G. **, Legnani C. **, Ferrari P. ***, Mirelli M., D'Addato M.
From the Department of Vascular Surgery University of Bologna, Italy
* Vascular Surgery Operating Unit “Infermi” Hospital, Rimini, Italy
** Division of Angiology and Coagulation Policlinico S. Orsola-Malpighi, Bologna, Italy
*** Medical Service, Alfa Wassermann, Bologna, Italy
Background. Carotid endarterectomy is usually followed by pharmacological therapy to prevent the onset of myointimal hyperplasia and to reduce the incidence of re-stenosis. A prospective study was carried out on three different drugs: on heparin and sulodexide to evaluate their inhibition activity on smooth muscle cells, and on ticlopidine to evaluate antiaggregating activity.
Methods. Patients with complicated plaque and/or hemodynamic stenosis (>75%), in both symptomatic and asymptomatic forms, were randomly divided into 3 treatment groups: group A, 20 patients, were treated with ticlopidine 250 mg×2/die; group B, 20 patients, were treated with sulodexide 1200 LRU/die for 1 month and then 500 LRU/die; group C, 19 patients, were treated with heparin calcium 5000 UI×3/die replaced after 15 days by ticlopidine 250 mg×2/die. Each therapy lasted for a total of six months.
Results. In the 51 patients evaluated myointimal thickening (expressed as a narrowing between 10 and 20% of internal carotid diameter) occurred, without significant differences, in 7 (37%) cases in group A, 4 (25%) cases in group B and 3 (19%) cases in group C; there was one restenosis of the internal carotid in the latter group. Owing to the small numbers included in the study, no statistically significant differences were identified by correlating risk factors with morphological lesions, in spite of the numerical differences. Hematological results showed a significant prolongation of aPTT in group C (heparin phase) with 5 cases of hematoma in the first 7 days after surgery. There was also 1 hematoma in group A and none in group B.
Conclusions. The fewest cases of thickening were observed during treatment with drugs in the glucosaminoglycan class, even if, owing to the small number of patients involved, the results were not statistically significant. The results also show that, by prolonging coagulation time, heparin may lead to a greater risk of hematoma.