title: The perioperative management of patients with coronary artery stents: surveying the clinical stakeholders and arriving at a consensus regarding optimal care.
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.
authors.affiliation: Department of Anesthesiology, University of Alabama School of Medicine, JT862, 619 19th Street South, Birmingham, AL 35249-6810, USA. tvetter@uab.edu
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Vetter
authors.forename: Arthur M
authors.initials: AM
authors.lastname: Boudreaux
authors.forename: Silvio E
authors.initials: SE
authors.lastname: Papapietro
authors.forename: Perry W
authors.initials: PW
authors.lastname: Smith
authors.forename: Benjamin B
authors.initials: BB
authors.lastname: Taylor
authors.forename: John R
authors.initials: JR
authors.lastname: Porterfield
mesh_terms: D000328:Adult; D026683:Advisory Committees; D000407:Alabama; D000776:Anesthesiology; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D006328:Cardiac Catheterization; D002309:Cardiology; D000077144:Clopidogrel; D032921:Consensus; D003331:Coronary Vessels; D003430:Cross-Sectional Studies; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D013502:General Surgery; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000517:prevention & control*; D019990:Perioperative Care / Q000379:methods*; D059035:Perioperative Period; D010820:Physicians / Q000706:statistics & numerical data*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects*; D011320:Primary Health Care; D012307:Risk Factors; D012494:Sampling Studies; D015607:Stents / Q000009:adverse effects*; D011795:Surveys and Questionnaires; D013927:Thrombosis / Q000209:etiology* / Q000517:prevention & control; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D000078329:Workforce
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin