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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.

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