Current practice in the use of antiplatelet agents in the peri-operative period by UK vascular surgeons.
BACKGROUND
There currently appears to be no firm consensus with regards to the use of antiplatelet agents during the peri-operative period in vascular surgical practice.


METHODS
A nine-part questionnaire relating to peri-operative antiplatelet use was sent to 137 ordinary members of the Vascular Surgical Society of Great Britain and Ireland (VSS-GBI).


RESULTS
Of the 137 questionnaires sent, 90 were returned (66%). For patients undergoing infra-inguinal bypass, carotid endarterectomy and varicose vein surgery, over 90% of vascular surgeons continue antiplatelet agents peri-operatively; however, in the case of aortic aneurysm repair, this figure is lower (77%). Three of the respondents stated that they would stop clopidogrel, but not aspirin, prior to surgery because of concerns over increased operative bleeding. In patients starting routine heparin prophylaxis against thrombosis, most surgeons opted to continue antiplatelet therapy (82%), although in patients requiring therapeutic heparin treatment, opinions were almost equally split. Most vascular surgeons (93%) would to start an alternative antiplatelet agent if a patient was intolerant of aspirin for gastrointestinal reasons.


CONCLUSIONS
Although the benefits of antiplatelet drugs in the long-term reduction of vascular events is established, evidence supporting their use in the peri-operative period is scarce. The general consensus of opinion from this survey suggests that most vascular surgeons do not stop antiplatelet drugs pre-operatively.
Smout
Jonathan
J
Department of Surgery and Northern Vascular Unit, Freeman Hospital, Newcastle upon Tyne, UK.
Stansby
Gerard
G
D017544:Aortic Aneurysm, Abdominal / Q000150:complications; D001241:Aspirin; D032921:Consensus; D000075202:Contraindications; D005767:Gastrointestinal Diseases / Q000150:complications / Q000517:prevention & control; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D007494:Ireland; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011364:Professional Practice; D011795:Surveys and Questionnaires; D006113:United Kingdom; D014656:Vascular Surgical Procedures / Q000379:methods*
D010975:Platelet Aggregation Inhibitors; D001241:Aspirin