Peri-operative management of anti-platelet agents.
BACKGROUND
Increasing numbers of patients treated with anti-platelet agents are presenting for non-cardiac surgery. We examined the peri-operative management of anti-platelet therapy in patients undergoing elective non-cardiac surgery and the process by which patients received instructions.


METHODS
We interviewed and collected outcome data on 213 consecutive patients aged > or = 45 years presenting for elective non-cardiac surgery at our institution over a 6-week period regarding the peri-operative management of anti-platelet and warfarin therapy.


RESULTS
Anti-platelet therapy was prescribed in 22.5% and warfarin in 5.2% of the study subjects. Aspirin was stopped peri-operatively in 55.3%, while clopidogrel was stopped in the sole patient treated with this. The frequency of anti-platelet agent discontinuation was similar for major and minor surgery. Warfarin was discontinued prior to surgery in all cases. Only 54.2% of those treated with anti-platelet therapy recalled being given instruction regarding pre-operative management of their anti-platelet therapy compared with 90.9% of patients treated with warfarin (P= 0.04). In the absence of instructions, a number of patients made their own decision to stop their aspirin pre-operatively. Post-operatively, only 37% recalled receiving instructions regarding restarting anti-platelet therapy. As a result, three patients failed to do so. In contrast, all those treated with warfarin received clear post-operative instructions.


CONCLUSIONS
Peri-operative anti-platelet management and communication with patients appears to be sub-optimal. There is a need for standardized processes whereby informed decisions regarding peri-operative anti-platelet therapy are made and communicated clearly to the patients.
Hermiz
Samer
S
Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand.
Larsen
Peter
P
Galletly
Duncan C
DC
Harding
Scott A
SA
D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000008:administration & dosage; D016009:Chi-Square Distribution; D000077144:Clopidogrel; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011300:Preoperative Care; D013514:Surgical Procedures, Operative; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D014859:Warfarin / Q000008:administration & dosage
D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin