Clinical science
The perioperative management of patients with coronary artery stents: surveying the clinical stakeholders and arriving at a consensus regarding optimal care

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Abstract

Background

The perioperative management of patients with a coronary artery stent is a major patient safety issue currently confronting clinicians. Surgery on a patient on antiplatelet therapy creates the following dilemma: is it better to withdraw the drugs and reduce the hemorrhagic risk or to maintain them and reduce the risk of a myocardial ischemic event?

Methods

An electronic survey was used to sample a cross-section of local clinicians regarding the perioperative management of patients with an indwelling coronary artery stent. The reiterative Consensus-Oriented Decision-Making model was applied by an institutional task force with representation from anesthesiology, cardiology, primary care medicine, and surgery.

Results

Significant disagreement existed among the multidisciplinary survey respondents regarding various aspects of the perioperative management of patients with indwelling coronary artery stents.

Conclusions

We clarified the perioperative risk factors for coronary stent thrombosis and an alternate process for immediate access to a cardiac catheterization laboratory at our institution.

Section snippets

Survey participants

Potential study participants were recruited from the University of Alabama at Birmingham (UAB) School of Medicine full-time faculty. Our cross-sectional, convenience sample of clinicians involved in the perioperative continuum of care of patients with indwelling coronary artery stents included anesthesiologists, cardiologists, primary care physicians, and surgeons.

Survey delivery

This study was approved by the UAB Institutional Review Board. Written informed consent was obtained from all study subjects before

Results

A total of 112 (41%) of the 275 invited UAB School of Medicine full-time clinical faculty participated in this study. Specifically, 26 anesthesiologists (51% response rate), 17 cardiologists (47% response rate), 31 primary care physicians (44% response rate), and 38 surgeons (35% response rate) were enrolled.

There was a significant overall disagreement among the 4 specialty groups about the need for perioperative continuation of aspirin in all patients (P < .001) and in patients at low risk (P

Comments

In 2008, a policy for the perioperative management of patients with an indwelling coronary artery stent was created at our institution. In the interim, it had become apparent that this initial policy did not adequately address the recurrent scenario of major surgery being performed at our satellite hospital without an onsite cardiac catheterization laboratory and the common clinical concern of balancing the increased risk of acute stent thrombosis with intraoperative blood loss while on versus

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