[Perioperative management of antiplatelet therapy in thoracic surgery. A survey of German hospitals].
BACKGROUND
The common practice to stop therapy with acetylsalicylic acid (aspirin) and/or clopidogrel perioperatively is critically discussed in the literature. There are no generally accepted guidelines for the handling of this problem. In this article the present strategy of perioperative antiplatelet therapy applied in German thoracic surgery departments was investigated.


METHODS
Questionnaires were sent to the heads of thoracic surgery departments registered in the German Society of Thoracic Surgery (n = 133) inquiring about the handling of aspirin and clopidogrel before elective thoracic surgical procedures. The return ratio was 59% (n = 78).


RESULTS
The analysis of the survey results showed a heterogeneous approach. Of the respondents 51-53% reported stopping aspirin therapy before surgery if the patient was taking aspirin due to a bare metal stent (implantation 3 months before). An even larger number of respondents stopped aspirin therapy before surgery if the patient was taking aspirin due to an ischemic insult or due to peripheral arterial disease with infrainguinal stenting (59-63% and 59-65%, respectively). In the case of drug-eluting stent implantation (implantation 3 months before) 34-41% of the respondents completely stopped the dual antiplatelet therapy before surgery and only 6-8% of the surgeons proceeded with surgery under dual platelet inhibition. Of the thoracic surgeons questioned 28% considered the existing data sufficient to manage this problem. Those surgeons who considered the existing data concerning the management of perioperative antiplatelet therapy as adequate had a stronger tendency to continue the antiplatelet therapy perioperatively. The aspirin and clopidogrel therapy was usually stopped 5-7 days preoperatively.


CONCLUSIONS
The survey showed that in Germany the majority of thoracic surgeons reduce or stop antiplatelet therapy (given as secondary prophylaxis) before surgical procedures. It can be assumed that patients are therefore exposed to an increased risk of cardiovascular morbidity and mortality.
Abt. Thoraxchirurgie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland. sebastian.wiesemann@uniklinik-freiburg.de
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Passlick
D001157:Arterial Occlusive Diseases / Q000188:drug therapy; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects*; D001291:Attitude of Health Personnel; D002545:Brain Ischemia / Q000188:drug therapy; D000077144:Clopidogrel; D003131:Combined Modality Therapy; D003625:Data Collection; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D005858:Germany; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy; D019990:Perioperative Care; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D015607:Stents; D011795:Surveys and Questionnaires; D019616:Thoracic Surgical Procedures; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin