{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T04:32:19Z","timestamp":1784003539802,"version":"3.55.0"},"reference-count":47,"publisher":"Elsevier BV","issue":"4","license":[{"start":{"date-parts":[[2022,4,1]],"date-time":"2022-04-01T00:00:00Z","timestamp":1648771200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2022,4,1]],"date-time":"2022-04-01T00:00:00Z","timestamp":1648771200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2023,4,1]],"date-time":"2023-04-01T00:00:00Z","timestamp":1680307200000},"content-version":"vor","delay-in-days":365,"URL":"http:\/\/www.elsevier.com\/open-access\/userlicense\/1.0\/"}],"funder":[{"DOI":"10.13039\/100012021","name":"Iran University of Medical Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012021","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","ejves.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Vascular and Endovascular Surgery"],"published-print":{"date-parts":[[2022,4]]},"DOI":"10.1016\/j.ejvs.2021.12.037","type":"journal-article","created":{"date-parts":[[2022,2,28]],"date-time":"2022-02-28T16:42:55Z","timestamp":1646066575000},"page":"546-555","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":21,"title":["Editor's Choice \u2013 Peri-Operative Outcomes of Carotid Endarterectomy are Not Improved on Dual Antiplatelet Therapy vs. Aspirin Monotherapy: A Systematic Review and Meta-Analysis"],"prefix":"10.1016","volume":"63","author":[{"given":"Jerry C.","family":"Ku","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shervin","family":"Taslimi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Zuccato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher R.","family":"Pasarikovski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1660-8718","authenticated-orcid":false,"given":"Nathalie","family":"Nasr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ofir","family":"Chechik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emiliano","family":"Chisci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0724-0237","authenticated-orcid":false,"given":"Daniele","family":"Bissacco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Larrue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yefim","family":"Rabinovich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Michelagnoli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piergiorgio G.","family":"Settembrini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano M.","family":"Priola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D.","family":"Cusimano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor X.D.","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. Loch","family":"Macdonald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.ejvs.2021.12.037_bib1","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1056\/NEJM199108153250701","article-title":"Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis","volume":"325","author":"Barnett","year":"1991","journal-title":"N\u00a0Engl J Med"},{"key":"10.1016\/j.ejvs.2021.12.037_bib2","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1056\/NEJM199811123392002","article-title":"Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators","volume":"339","author":"Barnett","year":"1998","journal-title":"N\u00a0Engl J Med"},{"key":"10.1016\/j.ejvs.2021.12.037_bib3","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1016\/S0140-6736(10)61197-X","article-title":"10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1): a multicentre randomised trial","volume":"376","author":"Halliday","year":"2010","journal-title":"Lancet"},{"key":"10.1016\/j.ejvs.2021.12.037_bib4","doi-asserted-by":"crossref","first-page":"1759","DOI":"10.1161\/01.STR.30.9.1759","article-title":"Medical complications associated with carotid endarterectomy. North American Symptomatic Carotid Endarterectomy Trial (NASCET)","volume":"30","author":"Paciaroni","year":"1999","journal-title":"Stroke"},{"key":"10.1016\/j.ejvs.2021.12.037_bib5","first-page":"CD001458","article-title":"Antiplatelet therapy for preventing stroke and other vascular events after carotid endarterectomy","volume":"3","author":"Engelter","year":"2003","journal-title":"Cochrane Database Syst Rev"},{"key":"10.1016\/j.ejvs.2021.12.037_bib6","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1177\/0003319717706626","article-title":"Medical therapy before carotid endarterectomy: changes over a 13-year period and comparison between asymptomatic and symptomatic patients","volume":"69","author":"Bissacco","year":"2018","journal-title":"Angiology"},{"key":"10.1016\/j.ejvs.2021.12.037_bib7","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1016\/j.ejvs.2009.07.001","article-title":"Variations in the pharmacological management of patients treated with carotid endarterectomy: a survey of European vascular surgeons","volume":"38","author":"Hamish","year":"2009","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"10.1016\/j.ejvs.2021.12.037_bib8","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1016\/j.ejvs.2015.11.002","article-title":"Antiplatelet Therapy in Carotid Artery Stenting and Carotid Endarterectomy in the Asymptomatic Carotid Surgery Trial-2","volume":"51","author":"Huibers","year":"2016","journal-title":"Eur J Vasc Endovasc"},{"key":"10.1016\/j.ejvs.2021.12.037_bib9","doi-asserted-by":"crossref","first-page":"1262","DOI":"10.1016\/j.jvs.2015.12.020","article-title":"Dual antiplatelet therapy reduces stroke but increases bleeding at the time of carotid endarterectomy","volume":"63","author":"Jones","year":"2016","journal-title":"J\u00a0Vasc Surg"},{"key":"10.1016\/j.ejvs.2021.12.037_bib10","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.avsg.2016.09.012","article-title":"Dual antiplatelet therapy does not increase the risk of bleeding after carotid endarterectomy: results of a prospective study","volume":"40","author":"Illuminati","year":"2017","journal-title":"Ann Vasc Surg"},{"key":"10.1016\/j.ejvs.2021.12.037_bib11","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1016\/j.jvs.2018.01.063","article-title":"Different perioperative antiplatelet therapies for patients treated with carotid endarterectomy in routine practice","volume":"68","author":"Zimmermann","year":"2018","journal-title":"J\u00a0Vasc Surg"},{"key":"10.1016\/j.ejvs.2021.12.037_bib12","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.ejvs.2016.10.011","article-title":"Systematic review and meta-analysis of dual versus single antiplatelet therapy in carotid interventions","volume":"53","author":"Barkat","year":"2017","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"10.1016\/j.ejvs.2021.12.037_bib13","doi-asserted-by":"crossref","first-page":"e598","DOI":"10.1016\/j.wneu.2019.12.070","article-title":"Dual versus single antiplatelet therapy in carotid artery endarterectomy: direct comparison of complications related to antiplatelet therapy","volume":"135","author":"Jiang","year":"2020","journal-title":"World Neurosurg"},{"key":"10.1016\/j.ejvs.2021.12.037_bib14","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1016\/j.ejvs.2015.07.019","article-title":"Dual antiplatelet therapy prior to expedited carotid surgery reduces recurrent events prior to surgery without significantly increasing peri-operative bleeding complications","volume":"50","author":"Batchelder","year":"2015","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"10.1016\/j.ejvs.2021.12.037_bib15","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1177\/1708538113478763","article-title":"Combined clopidogrel and aspirin therapy in patients undergoing carotid endarterectomy is associated with an increased risk of postoperative bleeding","volume":"21","author":"Hale","year":"2013","journal-title":"Vascular"},{"key":"10.1016\/j.ejvs.2021.12.037_bib16","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1002\/sim.2528","article-title":"Much ado about nothing: a comparison of the performance of meta-analytical methods with rare events","volume":"26","author":"Bradburn","year":"2007","journal-title":"Stat Med"},{"key":"10.1016\/j.ejvs.2021.12.037_bib17","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/1471-2288-7-5","article-title":"Inclusion of zero total event trials in meta-analyses maintains analytic consistency and incorporates all available data","volume":"7","author":"Friedrich","year":"2007","journal-title":"BMC Med Res Methodol"},{"key":"10.1016\/j.ejvs.2021.12.037_bib18","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1159\/000334180","article-title":"How to deal with measures of association: a short guide for the clinician","volume":"33","author":"Knol","year":"2012","journal-title":"Cerebrovasc Dis"},{"key":"10.1016\/j.ejvs.2021.12.037_bib19","first-page":"e464","article-title":"2011 ASA\/ACCF\/AHA\/AANN\/AANS\/ACR\/ASNR\/CNS\/SAIP\/SCAI\/SIR\/SNIS\/SVM\/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease","volume":"42","author":"Brott","year":"2011","journal-title":"Stroke"},{"key":"10.1016\/j.ejvs.2021.12.037_bib20","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.ejvs.2017.06.021","article-title":"Editor\u2019s choice - Management of atherosclerotic carotid and vertebral artery disease: 2017 clinical practice guidelines of the European Society for Vascular Surgery (ESVS)","volume":"55","author":"Naylor","year":"2018","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"10.1016\/j.ejvs.2021.12.037_bib21","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1016\/j.ejvs.2016.05.019","article-title":"Transcranial Doppler ultrasound detection of microemboli as a predictor of cerebral events in patients with symptomatic and asymptomatic carotid disease: a systematic review and meta-analysis","volume":"52","author":"Best","year":"2016","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"10.1016\/j.ejvs.2021.12.037_bib22","doi-asserted-by":"crossref","first-page":"3711","DOI":"10.1161\/STROKEAHA.109.563056","article-title":"Doppler embolic signals in cerebrovascular disease and prediction of stroke risk: a systematic review and meta-analysis","volume":"40","author":"King","year":"2009","journal-title":"Stroke"},{"key":"10.1016\/j.ejvs.2021.12.037_bib23","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1000097","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"6","author":"Moher","year":"2009","journal-title":"PLoS Med"},{"key":"10.1016\/j.ejvs.2021.12.037_bib24","unstructured":"OCEBM Levels of Evidence Working Group. The Oxford Levels of Evidence 2. Available at: https:\/\/www.cebm.ox.ac.uk\/resources\/levels-of-evidence\/ocebm-levels-of-evidence [Accessed 11 January 2022]."},{"key":"10.1016\/j.ejvs.2021.12.037_bib25","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1007\/s00423-012-0967-z","article-title":"Risk of wound hematoma at carotid endarterectomy under dual antiplatelet therapy","volume":"397","author":"Oldag","year":"2012","journal-title":"Langenbecks Arch Surg"},{"key":"10.1016\/j.ejvs.2021.12.037_bib26","doi-asserted-by":"crossref","first-page":"1476","DOI":"10.1161\/01.CIR.0000121739.05643.E6","article-title":"Beneficial effects of clopidogrel combined with aspirin in reducing cerebral emboli in patients undergoing carotid endarterectomy","volume":"109","author":"Payne","year":"2004","journal-title":"Circulation"},{"key":"10.1016\/j.ejvs.2021.12.037_bib27","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.ejvs.2010.04.004","article-title":"Dual antiplatelet therapy prior to carotid endarterectomy reduces post-operative embolisation and thromboembolic events: post-operative transcranial Doppler monitoring is now unnecessary","volume":"40","author":"Sharpe","year":"2010","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"10.1016\/j.ejvs.2021.12.037_bib28","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1016\/j.jvs.2011.03.003","article-title":"Clopidogrel is not associated with major bleeding complications during peripheral arterial surgery","volume":"54","author":"Stone","year":"2011","journal-title":"J\u00a0Vasc Surg"},{"key":"10.1016\/j.ejvs.2021.12.037_bib29","doi-asserted-by":"crossref","first-page":"154","DOI":"10.2310\/6670.2008.00027","article-title":"Perioperative microemboli and platelet aggregation in patients undergoing carotid endarterectomy","volume":"16","author":"Vogten","year":"2008","journal-title":"Vascular"},{"key":"10.1016\/j.ejvs.2021.12.037_bib30","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.jvs.2014.06.008","article-title":"Carotid artery stenting has increased risk of external carotid artery occlusion compared with carotid endarterectomy","volume":"61","author":"Brown","year":"2015","journal-title":"J\u00a0Vasc Surg"},{"key":"10.1016\/j.ejvs.2021.12.037_bib31","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1258\/vasc.2011.oa0336","article-title":"Blood loss and complications following carotid endarterectomy in patients treated with clopidogrel","volume":"20","author":"Chechik","year":"2012","journal-title":"Vascular"},{"key":"10.1016\/j.ejvs.2021.12.037_bib32","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1016\/j.jvs.2016.04.029","article-title":"Cranial nerve injury is associated with dual antiplatelet therapy use and cervical hematoma after carotid endarterectomy","volume":"64","author":"Chisci","year":"2016","journal-title":"J\u00a0Vasc Surg"},{"key":"10.1016\/j.ejvs.2021.12.037_bib33","doi-asserted-by":"crossref","first-page":"519","DOI":"10.5603\/FM.a2017.0009","article-title":"Concomitant fenestration and phlebectasia of the right internal jugular vein: a unique finding in anatomical dissection","volume":"76","author":"Cvetko","year":"2017","journal-title":"Folia Morphol (Warsz)"},{"key":"10.1016\/j.ejvs.2021.12.037_bib34","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1016\/j.jvs.2011.09.054","article-title":"Carotid endarterectomy in the acute phase of stroke-in-evolution is safe and effective in selected patients","volume":"55","author":"Leseche","year":"2012","journal-title":"J\u00a0Vasc Surg"},{"key":"10.1016\/j.ejvs.2021.12.037_bib35","doi-asserted-by":"crossref","first-page":"e315","DOI":"10.1016\/j.wneu.2018.04.199","article-title":"Carotid endarterectomy and concurrent clopidogrel use: national practice patterns in the United States","volume":"116","author":"Mistry","year":"2018","journal-title":"World Neurosurg"},{"issue":"Suppl. 2","key":"10.1016\/j.ejvs.2021.12.037_bib36","first-page":"104","article-title":"Carotid endarterectomy in patients taking aspirin combined with clopidogrel","volume":"29","author":"Nasr","year":"2010","journal-title":"Cerebrovasc Dis"},{"key":"10.1016\/j.ejvs.2021.12.037_bib37","doi-asserted-by":"crossref","first-page":"1586","DOI":"10.1016\/j.jvs.2013.05.092","article-title":"Discontinuation of preoperative clopidogrel is unnecessary in peripheral arterial surgery","volume":"58","author":"Saadeh","year":"2013","journal-title":"J\u00a0Vasc Surg"},{"key":"10.1016\/j.ejvs.2021.12.037_bib38","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1016\/j.jvs.2013.10.087","article-title":"Dual antiplatelet therapy (clopidogrel and aspirin) is associated with increased all-cause mortality after carotid revascularization for asymptomatic carotid disease","volume":"59","author":"Alcocer","year":"2014","journal-title":"J\u00a0Vasc Surg"},{"key":"10.1016\/j.ejvs.2021.12.037_bib39","first-page":"5","article-title":"Safety of dual antiplatelet therapy after carotid endarterectomy for prevention of restenosis: a single center experience","volume":"9","author":"Barboza","year":"2016","journal-title":"J\u00a0Vasc Interv Neurol"},{"key":"10.1016\/j.ejvs.2021.12.037_bib40","doi-asserted-by":"crossref","first-page":"E214","DOI":"10.1093\/neuros\/nyy557","article-title":"Timing of carotid endarterectomy for symptomatic carotid stenosis: a snapshot of current trends and systematic review of literature on changing paradigm towards early surgery","volume":"85","author":"Savardekar","year":"2019","journal-title":"Neurosurgery"},{"key":"10.1016\/j.ejvs.2021.12.037_bib41","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1177\/1538574412465480","article-title":"Cervical hematoma following carotid endarterectomy is morbid and preventable: a 12-year case-controlled review","volume":"46","author":"Comerota","year":"2012","journal-title":"Vasc Endovascular Surg"},{"key":"10.1016\/j.ejvs.2021.12.037_bib42","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1001\/jama.299.5.532","article-title":"Incidence of death and acute myocardial infarction associated with stopping clopidogrel after acute coronary syndrome","volume":"299","author":"Ho","year":"2008","journal-title":"JAMA"},{"key":"10.1016\/j.ejvs.2021.12.037_bib43","doi-asserted-by":"crossref","first-page":"1621","DOI":"10.1016\/j.jcin.2017.06.001","article-title":"Risk of early adverse events after clopidogrel discontinuation in patients undergoing short-term dual antiplatelet therapy: an individual participant data analysis","volume":"10","author":"Piccolo","year":"2017","journal-title":"JACC Cardiovasc Interv"},{"key":"10.1016\/j.ejvs.2021.12.037_bib44","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1159\/000351144","article-title":"Discontinuation of antiplatelet study medication and risk of recurrent stroke and cardiovascular events: results from the PRoFESS study","volume":"35","author":"Weimar","year":"2013","journal-title":"Cerebrovasc Dis"},{"key":"10.1016\/j.ejvs.2021.12.037_bib45","first-page":"964","article-title":"Mechanisms of intracerebral hemorrhage after carotid endarterectomy","volume":"95","author":"Henderson","year":"2001","journal-title":"J\u00a0Neurosurg"},{"key":"10.1016\/j.ejvs.2021.12.037_bib46","doi-asserted-by":"crossref","first-page":"2782","DOI":"10.1161\/STROKEAHA.111.618769","article-title":"Intracranial hemorrhage is much more common after carotid stenting than after endarterectomy: evidence from the National Inpatient Sample","volume":"42","author":"McDonald","year":"2011","journal-title":"Stroke"},{"key":"10.1016\/j.ejvs.2021.12.037_bib47","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10016-004-0131-5","article-title":"The incidence of ischemic stroke versus intracerebral hemorrhage after carotid endarterectomy: a review of 2452 cases","volume":"19","author":"Wilson","year":"2005","journal-title":"Ann Vasc Surg"}],"container-title":["European Journal of Vascular and Endovascular Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1078588421010303?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1078588421010303?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T11:57:06Z","timestamp":1761047826000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1078588421010303"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4]]},"references-count":47,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2022,4]]}},"alternative-id":["S1078588421010303"],"URL":"https:\/\/doi.org\/10.1016\/j.ejvs.2021.12.037","relation":{},"ISSN":["1078-5884"],"issn-type":[{"value":"1078-5884","type":"print"}],"subject":[],"published":{"date-parts":[[2022,4]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Editor's Choice \u2013 Peri-Operative Outcomes of Carotid Endarterectomy are Not Improved on Dual Antiplatelet Therapy vs. Aspirin Monotherapy: A Systematic Review and Meta-Analysis","name":"articletitle","label":"Article Title"},{"value":"European Journal of Vascular and Endovascular Surgery","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.ejvs.2021.12.037","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2022 European Society for Vascular Surgery. Published by Elsevier B.V.","name":"copyright","label":"Copyright"}]}}