Antiplatelet Management Before Carotid Endarterectomy

Standard Perioperative Antiplatelet Protocol

• The American Heart Association recommends continuing aspirin (81-325 mg daily) before and through carotid endarterectomy, but stopping clopidogrel 5 days before surgery unless the patient is recently symptomatic (within 2 weeks), in which case dual antiplatelet therapy should be continued perioperatively 1
• Aspirin must be continued throughout the perioperative period without interruption, with low-dose aspirin (81-325 mg daily) being the recommended range 1

Postoperative Management

• After the first month post-CEA, the American College of Cardiology recommends continuing aspirin (75-325 mg daily), clopidogrel (75 mg daily), or aspirin plus extended-release dipyridamole for long-term prophylaxis against ischemic cardiovascular events 1
• Single antiplatelet therapy is generally preferred over dual therapy for long-term management due to bleeding risk considerations, according to the American Heart Association 2