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

The aim of this study was to investigate whether timing of heparin administration during carotid endarterectomy (CEA) could affect postoperative outcomes. 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, whereas in the second group (Group B), heparin was given 2 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. A total of 2167 patients underwent CEA: 1191 patients (55%) were treated in group A, whereas 979 (45%) were treated 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. After multivariate analysis, just wound hematoma evacuation rate was affected by the timing of heparin administration during CEA. The strategy of heparin administration before skin incision during CEA protects against wound hematoma evacuation without increasing the procedural risk.TableOutcomesGroup A, n = 1191 n (%)Group B, n = 979 n (%)P24-hour postoperative outcomes: primary outcomes Myocardial infarction5 (0.4%)4 (0.4%)1 Major stroke1 (0.1%)4 (0.4%).18 Minor stroke0 -2 (0.2%).2 Death0 (0%)1 (0.1%).45 Major adverse events6 (0.5)11 (1.1%).14 Surgical site hematoma48 (4%)29 (3%).2 Wound hematoma evacuation1 (0.1%)15 (1.5%).000130-day outcomes: secondary outcomes Myocardial infarction0 -4 (0.4%).04 Major stroke1 (0.1%)1 (0.1%)1 Minor stroke0 -2 (0.2%).2 Death00– Major adverse events1 (0.1%)7 (0.7%).02 Cranial nerve lesion1 (0.1%)1 (0.1%)1Boldface P values indicate statistical significance. Open table in a new tab