PMID- 19328023
OWN - NLM
STAT- MEDLINE
DCOM- 20090619
LR  - 20161125
IS  - 1532-2165 (Electronic)
IS  - 1078-5884 (Linking)
VI  - 37
IP  - 6
DP  - 2009 Jun
TI  - Low molecular weight heparin significantly reduces embolisation after carotid 
      endarterectomy--a randomised controlled trial.
PG  - 633-9
LID - 10.1016/j.ejvs.2009.02.009 [doi]
AB  - OBJECTIVES: The administration of unfractionated heparin (UFH) prior to carotid 
      clamping during carotid endarterectomy (CEA) transiently increases the platelet 
      aggregation response to arachidonic acid (AA) despite the use of aspirin. We 
      hypothesized that this phenomenon might be reduced by using low molecular weight 
      heparin (LMWH) resulting in fewer emboli in the early post-operative period. 
      METHODS: 183 aspirinated patients undergoing CEA were randomised to 5000 IU UFH 
      (n=91) or 2500 IU LMWH (dalteparin, n=92) prior to carotid clamping. End-points 
      were: transcranial Doppler (TCD) measurement of embolisation, effect on bleeding 
      and platelet aggregation to AA and adenosine 5'-diphosphate (ADP). RESULTS: 
      Patients randomised to UFH had twice the odds of experiencing a higher number of 
      emboli in the first 3h after CEA, than those randomised to LMWH (p=0.04). This 
      was not associated with increased bleeding (mean time from flow restoration to 
      operation end: 23 min (UFH) vs. 24 min (LMWH), p=0.18). Platelet aggregation to 
      AA increased significantly following heparinisation, but was unaffected by 
      heparin type (p=0.90). The platelets of patients randomised to LMWH exhibited 
      significantly lower aggregation to ADP compared to UFH (p<0.0001). CONCLUSIONS: 
      Intravenous LMWH is associated with a significant reduction in post-operative 
      embolisation without increased bleeding. The higher rate of embolisation seen 
      with UFH may be mediated by increased platelet aggregation to ADP, rather than to 
      AA.
FAU - McMahon, G S
AU  - McMahon GS
AD  - Department of Cardiovascular Sciences, University of Leicester, Leicester Royal 
      Infirmary, Leicester, UK. gregmcmahon@hotmail.com
FAU - Webster, S E
AU  - Webster SE
FAU - Hayes, P D
AU  - Hayes PD
FAU - Jones, C I
AU  - Jones CI
FAU - Goodall, A H
AU  - Goodall AH
FAU - Naylor, A R
AU  - Naylor AR
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20090326
PL  - England
TA  - Eur J Vasc Endovasc Surg
JT  - European journal of vascular and endovascular surgery : the official journal of 
      the European Society for Vascular Surgery
JID - 9512728
RN  - 0 (Anticoagulants)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 27YG812J1I (Arachidonic Acid)
RN  - 61D2G4IYVH (Adenosine Diphosphate)
RN  - 9005-49-6 (Heparin)
RN  - R16CO5Y76E (Aspirin)
RN  - S79O08V79F (Dalteparin)
SB  - IM
MH  - Adenosine Diphosphate
MH  - Aged
MH  - Anticoagulants/administration & dosage/adverse effects/*therapeutic use
MH  - Arachidonic Acid
MH  - Aspirin/therapeutic use
MH  - Carotid Artery Diseases/blood/diagnostic imaging/mortality/*surgery
MH  - Dalteparin/administration & dosage/adverse effects/*therapeutic use
MH  - Double-Blind Method
MH  - Drug Therapy, Combination
MH  - Endarterectomy, Carotid/*adverse effects/mortality
MH  - Female
MH  - Hemorrhage/chemically induced
MH  - Heparin/administration & dosage/adverse effects/*therapeutic use
MH  - Humans
MH  - Infusions, Intravenous
MH  - Intracranial Embolism/blood/diagnostic imaging/etiology/mortality/*prevention & 
      control
MH  - Male
MH  - Middle Aged
MH  - Odds Ratio
MH  - Platelet Aggregation/drug effects
MH  - Platelet Aggregation Inhibitors/therapeutic use
MH  - Risk Assessment
MH  - Stroke/blood/diagnostic imaging/etiology/mortality/*prevention & control
MH  - Time Factors
MH  - Treatment Outcome
MH  - Ultrasonography, Doppler, Transcranial
EDAT- 2009/03/31 09:00
MHDA- 2009/06/20 09:00
CRDT- 2009/03/31 09:00
PHST- 2008/11/09 00:00 [received]
PHST- 2009/02/22 00:00 [accepted]
PHST- 2009/03/31 09:00 [entrez]
PHST- 2009/03/31 09:00 [pubmed]
PHST- 2009/06/20 09:00 [medline]
AID - S1078-5884(09)00104-X [pii]
AID - 10.1016/j.ejvs.2009.02.009 [doi]
PST - ppublish
SO  - Eur J Vasc Endovasc Surg. 2009 Jun;37(6):633-9. doi: 10.1016/j.ejvs.2009.02.009. 
      Epub 2009 Mar 26.