Objective To systematically review the effect of discontinuation of antiplatelet therapy for postoperative bleeding in carotid endarterectomy(CEA) patients by meta-analysis.Methods We searched the PubMed, Embase, Cochrane library, CNKI, China Biology Medicine (CBM), Wanfang Database and VIP, and collected all the randomized controlled trials (RCTs) about this topic.The quality of the included studies was evaluated using the method recommended by Cochrane Collaboration.Meta-analysis was conducted using RevMan 5.3 software.Results Four RCTs involving 514 patients were included, 256 in the control group and 258 in the intervention group.All outcome measures were not heterogeneous (P>0.1, I2<50%), fixed effect model was used to analyze the outcomes.The results of meta-analysis showed that discontinuation of preoperative antiplatelet therapy could significantly reduce the risk ratio of postoperative stroke (RR=0.30, 95%CI 0.11-0.83, P=0.02).There was no significant difference in the risk of 30 d (RR=0.23, 95%CI 0.04-1.32, P=0.1) and 1-year mortality (RR=0.49, 95%CI 0.24-1.02, P=0.06), postoperative major bleeding (RR=1.40, 95%CI 0.54-3.59, P=0.49), postoperative bleeding complications (RR=1.02, 95%CI 0.15-6.96, P=0.98) and TIA (RR=1.08, 95%CI 0.47-2.49,P=0.86) between the two groups.Conclusion Discontinuation of preoperative aspirin therapy could significantly reduce the rate of postoperative stroke without increasing bleeding risk.

OBJECTIVE: To elucidate which one of &mgr;, delta and kappa opioid receptors is involved in the cardiovascular depression following traumatic hemorrhagic shock. METHODS: With traumatic hemorrhagic shock rat models, the changes of myocardial and brain &mgr;, delta and kappa opioid receptors and cardiovascular functions and their relationship with hemodynamic parameters were observed. The effects of delta and kappa opioid receptor antagonists on hemodynamic parameters of traumatic hemorrhagic shock rats were observed. RESULTS: Following traumatic hemorrhagic shock, the number of myocardial and brain delta and kappa opioid receptors significantly increased, their affinity did not alter, and the increased number of delta and kappa opioid receptors was significantly associated with the decreased hemodynamic parameters. However, &mgr; opioid receptor in heart and brain did not obviously change. delta opioid receptor antagonist ICI174,864 and kappa opioid receptor antagonist Nor-binaltorphimine (50 &mgr;g, Icv) could significantly reverse those decreased hemodynamic parameters. CONCLUSIONS: It suggests that opioid receptors, especially delta and kappa opioid receptors are closely related to the pathogenesis of traumatic hemorrhagic shock, and they play important roles in the depression of cardiovascular function following traumatic hemorrhagic shock.