501 Antiplatelet Therapy Following Coronary Artery Bypass Grafting: A Closed Loop Audit in a Tertiary Centre

Abstract

Abstract Aim Guidelines recommend 12 months of dual antiplatelet therapy (DAPT) for patients undergoing percutaneous coronary intervention (PCI) followed by emergency coronary artery bypass grafting (CABG). In patients with stable coronary artery disease (CAD) undergoing CABG, DAPT does not give a survival benefit but may prevent venous graft occlusion. Variation exists in practice between consultants with regards to duration of DAPT after CABG in stable CAD patients. Method All patients who underwent CABG in our centre in October and November 2020 were identified. Type and duration of antiplatelet and/or anticoagulant were recorded, as was history of MI and/or PCI. An antiplatelet prescription aid, taking into account surgeon preference, was designed and the effect on prescribing re-audited. Results 35 patients underwent CABG. All patients except 2 received lifelong aspirin or a DOAC/NOAC. 3 patients had STEMI/NSTEMI in the preceding 12 months; two received DAPT and one received aspirin and a DOAC. Variation exists for DAPT prescribing duration following CABG for stable CAD. Re-audit results shows improvement in consistency of prescribing following implementation of the prescription aid. Conclusions Adherence to DAPT guidelines following PCI and CABG is good. However, variation exists in DAPT prescribing in stable CAD patients, between consultants and between patients for the same consultant. Consistency improved with implementation of the prescription aid.