Perioperative Management of Antiplatelets in Elective Surgery at a Tertiary Hospital

Abstract

Background: Many undergoing elective surgery receive antiplatelets for cardiovascular secondary prevention. European Society of Cardiology (ESC) Guidelines (2017) outlined factors to assist perioperative management of antiplatelets in elective surgery. Aims: Evaluate: 1. Perioperative management of patients taking antiplatelets. 2. Bleeding, thrombosis & rehospitalisation rates. 3. Compliance with Guidelines. Methods: Retrospective analysis of adults undergoing elective surgery from 01/01/2017–01/04/2018 who received antiplatelets pre-operatively. Compliance with ESC Guidelines was rated according to thrombosis and bleeding risk factors. Results: Evaluated 182 patients, age 69 ± 12 years. Interrupting antiplatelets was compliant in 76.4%, duration of cessation was compliant in 26.4%. No difference between antiplatelet type/combinations and compliance was found. Of the 134 non-compliant patients, 73.1% had antiplatelets ceased later than advised. Aspirin cessation was closer to surgery than advised (80.3%, p = 0.027) and associated with increased bleeding (83.1%, p = 0.004). Clopidogrel monotherapy was associated with reduced bleeding (33.3%, p = 0.017). Less bleeding occurred in patients with gastro-oesophageal reflux disease: 17/26 (65%) vs 54/64 (84%) (p = 0.046). Cardiac surgery was associated with increased bleeding (89.0%, p < 0.001) despite higher compliance for interrupting or continuing antiplatelets (85.4%, p < 0.01). Thromboembolism occurred in 2 (1.1%), transfusion in 32 (17.6%), and 14 (7.7%) required rehospitalisation within 3 months. Conclusion: There is considerable compliance with recommendations regarding interruption/continuation of antiplatelets, but widespread discordance concerning duration of antiplatelet interruption, suggesting requirements for further Guideline dissemination/education.