SRS172 - Adherence to local guidelines for antiplatelet therapy after symptomatic carotid endarterectomy: a global survey

Abstract Background Long-term antiplatelet therapy reduces recurrent stroke after symptomatic carotid endarterectomy (sCEA). While both aspirin and clopidogrel are recommended, regional guidelines differ—and real-world practice may not always align. This study surveyed vascular surgeons to assess global prescribing patterns and compare them to local guideline recommendations. Methods Consultant vascular surgeons in four regions (UK, Europe, Australasia, Brazil) received an online questionnaire regarding their preferred long-term antiplatelet regimen following sCEA. We collected 357 responses (UK:192; Europe:107; Brazil:23; Australasia:35) and compared drug choices to regional guidelines. Mann–Whitney U tests (P < 0.05) and binary logistic regression were used to identify predictors of guideline adherence. Results Prescribing patterns varied significantly by region (P < 0.001). Clopidogrel was most common in the UK (80%), aligning with NICE guidance. Aspirin predominated in Australasia (89%) and Brazil (44%), consistent with local protocols. Guideline adherence was 80% in both the UK and Australasia (P > 0.05), but only 40% in Brazil. In Europe, aspirin and clopidogrel were similarly prescribed (43% 40%), despite ESVS guidance favouring clopidogrel, yielding 55% adherence. Dual-antiplatelet therapy was used by 9.5% overall, most frequently in Brazil (P < 0.01), despite guideline discouragement. Surgeon annual CEA volume and teaching-hospital status did not influence prescribing. Binary logistic regression confirmed region as the sole independent predictor of guideline adherence (P < 0.01). Conclusions Antiplatelet regimens post-sCEA vary globally. While most regions follow local guidelines, adherence is poorest in Europe and Brazil. Off-guideline dual therapy persists in 10% of cases. Improved dissemination and implementation strategies are needed to standardise prescribing and optimise stroke prevention.