A retrospective study showing the extent of compliance with perioperative guidelines in patients with coronary stents with regard to double antiplatelet therapy

J Clin Anesth. 2016 Sep;33:179-84. doi: 10.1016/j.jclinane.2016.01.030. Epub 2016 Apr 29.

Abstract

Study objective: To evaluate perioperative dual antiplatelet therapy management in patients with previously placed coronary stents.

Design: Retrospective medical record review.

Setting: Academic medical center.

Patients: A total of 1891 surgical cases performed at Vanderbilt University Medical Center in 2012 were evaluated using a perioperative database. Of these, 161 had complete data records that were evaluated using 2 evidence-based and expert opinion-supported protocols.

Interventions: N/A.

Measurements: This study is meant to evaluate perioperative antiplatelet management decisions in patients with coronary stents.

Main results: Management decisions were consistent with guidelines regarding antiplatelet therapy in 13% (21/161) of patients. Of the 87% (140/161) of cases where decisions were not consistent, 88% (123/140) were due to discontinuing aspirin preoperatively when there was not a high risk of surgical bleeding.

Conclusions: This study revealed suboptimal adherence to current perioperative antiplatelet management guidelines in patients with coronary stents. The lack of adherence to current guidelines is concerning and could be used to support the notion of an anesthesiologist-led Perioperative Surgical Home.

Keywords: Antiplatelet agents; Coronary stents; Dual antiplatelet therapy; Perioperative Surgical Home.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aspirin / administration & dosage
  • Aspirin / therapeutic use
  • Case Management
  • Clopidogrel
  • Coronary Vessels*
  • Female
  • Guideline Adherence / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Perioperative Care / standards*
  • Perioperative Care / statistics & numerical data
  • Platelet Aggregation Inhibitors / administration & dosage
  • Platelet Aggregation Inhibitors / therapeutic use*
  • Retrospective Studies
  • Stents*
  • Ticlopidine / analogs & derivatives
  • Ticlopidine / therapeutic use
  • Treatment Outcome

Substances

  • Platelet Aggregation Inhibitors
  • Clopidogrel
  • Ticlopidine
  • Aspirin