Abstract
Background Though guidelines for anti-platelet therapy in patients undergoing non-cardiac surgery in the year following drug-eluting stent (DES) placement exist, optimal management of these patients is unknown. Possible influences on provider practice include agreement with guidelines and personal experience with patients who have experienced stent thrombosis. We assessed these influences among VA providers' practices of anti-platelet use in DES patients with cardiac stents needing surgery in the subsequent year. Methods A national web-based survey was administered to VA cardiologists, surgeons, and anesthesiologists. The survey was distributed by the respective national directors via email. Responses were collected and compared with chi-square tests. Results 297 providers from 80 separate medical centers responded to the survey. Of these, 107 (36.0%) were cardiologists, 88 (29.6%) surgeons, and 92 (31.0%) anesthesiologists. In general, surgeons were less likely than cardiologists or anesthesiologists to continue dual anti-platelet therapy in the peri-operative period (Table 1). Agreement with guidelines did not significant affect these provider dual anti-platelet therapy practices, but personal experience with patients experiencing stent thrombosis increased surgeons' rates of dual anti-platelet therapy use by over 25% (Table 2). Conclusions Significant variation by provider in anti-platelet management among DES patients exists, which is partially mediated by personal experience with stent thrombosis. This variation points to the need for further clarity in optimal treatment, and the impact of personal experience on management decisions. Dual Anti-Platelet Practices in the Peri-Operative Period Among VA Providers Overall (N = 297) Cardiologists (N =107) Surgeons (N = 88) Anesthesiologists (N = 92) Other Providers (N = 10) P-value Continue dual antiplatelet therapy 214 (72.1%) 81 (75.7%) 53 (60.2%) 73 (79.4%) 7 (70%) 0.03 Continue aspirin only or stop all 83 (28%) 26 (24.3%) 35 (39.8%) 19 (20.7%) 3 (30%) Dual Anti-Platelet Practices by Guideline Agreement and Stent Thrombosis Experience Overall (N = 297) Cardiologists (N = 107) Surgeons (N = 88) Anesthesiologists (N = 92) Agree with Guidelines Disagree with Guidelines Agree with Guidelines Disagree with Guidelines Agree with Guidelines Disagree with Guidelines Agree with Guidelines Disagree with Guidelines Continue dual antiplatelet therapy 180 (73.5%) 34 (65.4%) 73 (74.5%) 8 (88.9%) 35 (61.4%) 18 (58.1%) 65 (80.3%) 8 (72.7%) Continue aspirin only or stop all 65 (26.5%) 18 (34.6%) 25 (25.5%) 1 (11.1%) 22 (38.6%) 13 (41.9%) 16 (19.8%) 3 (27.3%) Overall (N = 289) Cardiologists (N = 106) Surgeons (N = 84) Anesthesiologists (N = 92) Experience with Stent Thrombosis No Experience with Stent Thrombosis Experience with Stent Thrombosis No Experience with Stent Thrombosis Experience with Stent Thrombosis No Experience with Stent Thrombosis Experience with Stent Thrombosis No Experience with Stent Thrombosis Continue dual antiplatelet therapy 78 (78%) 130 (68.8%) 45 (79%) 35 (71.4%) 14 (82.4%) * 37 (55.2%) * 17 (73.9%) 56 (81.2%) Continue aspirin only or stop all 22 (22%) 59 (31.2%) 12 (21.1%) 14 (28.6%) 3 (17.7%) 30 (44.8%) 6 (26.1%) 13 (18.8%) * P-value = 0.05
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