This study states that A few months ago, I performed a carotid endarterectomy with a bovine patch in a patient taking aspirin and administered heparin in accordance with the activated clotting times. The findings from a completion intraoperative arteriogram, which our group routinely performs, were normal. The patient experienced a stroke postoperatively, and, on immediate reexploration, I found thrombus at the patched endarterectomized site but no intimal flap or other technical error. I had no explanation other than believing the endarterectomized site was thrombogenic. Therefore, I replaced the segment with a graft and administered clopidogrel and low-dose heparin postoperatively. Follow-up duplex ultrasound scans have shown a widely patent conduit, although he still has severe aphasia. I think about this patient, his wife, and his 22-year-old son almost daily (my son is 23 years old). Would preoperative testing, or even preoperative clopidogrel, have made a difference?

This article was designed to investigate changes in the response to antiplatelet prophylaxis in vascular surgery patients with symptomatic peripheral arterial disease or internal carotid stenosis.

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