Emboli rate during and early after carotid endarterectomy after a single preoperative dose of 120mg acetylsalicylic acid - A prospective double-blind placebo controlled randomised trial

Purpose: To investigate whether a single pre-operative dose of 120 mg acetylsalicylic acid (ASA) decreased either (1) emboli rate, as detected by transcranial Doppler (TCD), during and early after carotid endarterectomy (CEA) and (2) clinical intra- and post-operative signs suggestive of embolism or increased bleeding tendency. Design: Prospective, double-blind placebo controlled trial. Patients and methods: One-hundred consecutive patients were randomised to receive either 120 mg ASA (n=48) or placebo (n=49) by suppository on the night before CEA; three patients were excluded. Emboli were counted and expressed as emboli rate (ER). The incidence of bleeding complications was assessed. Surgeons were asked to indicate which patients had received ASA or placebo. Results: There were no significant differences between the ASA and placebo groups in ER in the intraoperative and postoperative periods. ER higher than 0.9 min^-1 was associated with a significantly increased risk of complications (26 vs. 0%, P<0.01). No extra bleeding complications were observed in the ASA group. Surgeon assessment of whether or not ASA had been administered had a sensitivity of 42% and a specificity of 70%. Conclusion: A single pre-operative dose of ASA (120 mg) did not reduce significantly the emboli rate during and after CEA and surgeons could not correctly identify whether or not ASA had been administered.