title: The peri-operative management of anti-platelet therapy in elective, non-cardiac surgery.
abstract: BACKGROUND
  Cardiovascular complications are important causes of morbidity and mortality in patients undergoing elective non-cardiac surgery, with adverse cardiac outcomes estimated to occur in approximately 4% of all patients. Anti-platelet therapy withdrawal may precede up to 10% of acute cardiovascular syndromes, with withdrawal in the peri-operative setting incompletely appraised.
  
  
  OBJECTIVE
  The aims of our study were to determine the proportion of patients undergoing elective non-cardiac surgery currently prescribed anti-platelet therapy, and identify current practice in peri-operative management. In addition, the relationship between management of anti-platelet therapy and peri-operative cardiac risk was assessed.
  
  
  METHODS
  We evaluated consecutive patients attending elective non-cardiac surgery at a major tertiary referral centre. Clinical and biochemical data were collected and analysed on patients currently prescribed anti-platelet therapy. Peri-operative management of anti-platelet therapy was compared with estimated peri-operative cardiac risk.
  
  
  RESULTS
  Included were 2950 consecutive patients, with 516 (17%) prescribed anti-platelet therapy, primarily for ischaemic heart disease. Two hundred and eighty nine (56%) patients had all anti-platelet therapy ceased in the peri-operative period, including 49% of patients with ischaemic heart disease and 46% of patients with previous coronary stenting. Peri-operative cardiac risk score did not influence anti-platelet therapy management.
  
  
  CONCLUSIONS
  Approximately 17% of patients undergoing elective non-cardiac surgery are prescribed anti-platelet therapy, the predominant indication being for ischaemic heart disease. Almost half of all patients with previous coronary stenting had no anti-platelet therapy during the peri-operative period. The decision to cease anti-platelet therapy, which occurred commonly, did not appear to be guided by peri-operative cardiac risk stratification.
authors.affiliation: Department of Cardiology, Concord Repatriation General Hospital, University of Sydney, Sydney, Australia.
authors.forename: Richard F
authors.initials: RF
authors.lastname: Alcock
authors.forename: Chris
authors.initials: C
authors.lastname: Naoum
authors.forename: Bernadette
authors.initials: B
authors.lastname: Aliprandi-Costa
authors.forename: Graham S
authors.initials: GS
authors.lastname: Hillis
authors.forename: David B
authors.initials: DB
authors.lastname: Brieger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D019990:Perioperative Care / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D010975:Platelet Aggregation Inhibitors