title: Perioperative prophylactic antithrombotic strategies in vascular surgery: current practice in the Netherlands.
abstract: OBJECTIVE
  The aim of this study was to evaluate the current practice of the use of perioperative antithrombotic drugs to prevent arterial thrombo-embolic complications during arterial vascular surgery by Dutch vascular surgeons. Aim was also to compare the results with the literature and to evaluate the effect of guidelines.
  
  
  METHODS
  A comprehensive questionnaire was sent to all Dutch vascular surgeons performing arterial reconstructive surgery.
  
  
  RESULTS
  The response rate was 84%. Acetylsalicylic acid (ASA) was continued perioperatively by most surgeons (91%). Clopidogrel was discontinued by the majority of respondents (65%). During operation 97% of surgeons administered unfractionated heparin (UFH) before arterial clamping. A minority (11%) measures peroperatively anticoagulant activity in patients' blood. After infrainguinal venous bypass most surgeons (81%) preferred monotherapy with vitamin K antagonists (VKA), in agreement with the Dutch guideline in this respect. Before the introduction of the guideline in 2005, a survey was performed in 2004. Results of our 2011 survey showed more respondents (6% to 11%) prescribed ASA or VKA according to these guidelines.
  
  
  CONCLUSIONS
  This survey showed a recognizable pattern of variation for perioperative arterial thrombosis prophylaxis amongst Dutch vascular surgeons, in agreement with reports from other countries over the past 20 years. Although a higher percentage of surgeons complied in 2011 with existing guidelines than in 2004, guidelines were not completely met. Possibly because current guidelines are not fully supported by evidence and do not cover all aspects of perioperative arterial thrombosis prophylaxis. Clearly there is need for (more) convincing data based on RCT's concerning the various aspects of perioperative arterial thrombosis prophylaxis.
authors: Department of Surgery, Westfriesgasthuis Hoorn, The Netherlands - arno@wiersema.nu.
authors: A
authors: A
authors: Wiersema
authors: C
authors: C
authors: Bruijninckx
authors: M
authors: M
authors: Reijnen
authors: J
authors: J
authors: Vos
authors: O
authors: O
authors: Van Delden
authors: A
authors: A
authors: Vahl
authors: C
authors: C
authors: Zeebregts
authors: F
authors: F
authors: Moll
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D019983:Guideline Adherence / Q000639:trends; D019538:Health Care Surveys; D006801:Humans; D009426:Netherlands; D019990:Perioperative Care; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011795:Surveys and Questionnaires; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents