• Hanaa Dakour-Aridi, Raghu L Motaganahalli, Andres Fajardo, Akiko Tanaka, Naveed U Saqib, Gordon H Martin, Aleem Mirza, Arash Keyhani, Kourosh Keyhani, and Shihuan Keisin Wang.
• Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
• Ann. Surg. 2023 Sep 1; 278 (3): e620e625e620-e625.

ObjectiveTo define the risks associated with the replacement of dual antiplatelets for alternate medication regimens.BackgroundPatients undergoing transcarotid artery revascularization (TCAR) for atherosclerotic disease in the Vascular Quality Initiative database from September 2016 to June 2022 were included. In all, 29,802 TCAR procedures were captured between 2016 and 2022, consisting of 24,651 (82.7%) maintained on dual antiplatelet therapy (DAPT) and 5151 (17.3%) on alternative regimens.MethodsPatients maintained on DAPT were compared with those on alternative regimens consisting of any combination of single antiplatelet monotherapy and/or anticoagulation.ResultsOn univariable analysis, patients on alternative medications were more likely to experience in-hospital death, ipsilateral stroke, any stroke, and transient ischemic attacks compared with patients in the DAPT group. The mortality rate was higher at 1 year in the alternative cohort (4.7% vs 7.0%, P <0.01). The use of alternate medication regimens was associated with increased odds of stroke and the composite outcome of in-hospital stroke/death compared with DAPT. There was also a significant association between alternative medication use and increased odds of in-hospital transient ischemic attack, immediate stent occlusion, and return to the operating room. At 1 year, there was no significant difference in the incidence of stroke between the 2 groups. However, the use of alternate regimens was associated with higher 1-year of mortality after multivariable adjustment.ConclusionsPatients not maintained on DAPT after TCAR experienced an increased risk of stroke and death in the perioperative and follow-up periods. Increased surgeon vigilance is required to ensure compliance with dual antiplatelets as recommended.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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