Carotid Endarterectomy in Patients With Thrombocytopenia: Analysis of the National Surgical Quality Improvement Program Registry.

BACKGROUND Carotid endarterectomy (CEA) is infrequently performed in patients with mild to moderate thrombocytopenia. OBJECTIVE To determine whether preoperative thrombocytopenia is associated with a higher rate of complications after CEA. METHODS We analyzed patient characteristics, comorbid conditions, operative details, and 30-day postoperative outcomes for patients who underwent CEA in the CEA-targeted American College of Surgeons National Surgical Quality Improvement Program Registry. Thrombocytopenia was defined based on the preprocedure platelet count of ≤150  000 platelets/μL. The odds ratios (ORs) for selected outcomes were calculated using logistic regression with stepwise forward selection with age, sex, symptomatic status, and high-risk individuals as potential confounders. RESULTS Thrombocytopenia was present in 896 of 8658 patients (10.3%) who underwent CEA: mild (100 000-149 000 platelets/μL) and moderate (50 000-99 000 platelets/μL) in 805 patients (89.8%) and 91 patients (10.2%), respectively. The adjusted rates of myocardial infarction/arrhythmia (3.7% vs 1.8%; OR: 1.9; 95% confidence interval [CI]: 1.3-2.8; P = .001), unplanned intubations (2.6% vs 1.2%; OR: 2.2; 95% CI: 1.4-3.5; P = .001), ventilator requirement >48 hours (1.5% vs 0.7%; OR: 2.1; 95% CI: 1.1-3.8; P = .02), deep venous thrombosis/thrombophlebitis (0.7% vs 0.2%; OR: 3.7; 95% CI: 1.4-9.7; P = .01), and surgical deep incisional infections (0.3% vs 0.1%; OR: 4.3; 95% CI: 1.1-17.4; P = .04) post-CEA were higher among patients with thrombocytopenia compared with those without thrombocytopenia. Thrombocytopenia did not significantly contribute to 1-month mortality or stroke. CONCLUSION The higher rate of postprocedure complications in patients with preoperative thrombocytopenia needs to be recognized for adequate risk stratification before CEA.