title: Dual antiplatelet therapy use by Canadian cardiac surgeons.
abstract: BACKGROUND
  Dual antiplatelet therapy is the cornerstone treatment for patients with acute coronary syndrome. Recent Canadian Guidelines recommend the use of dual antiplatelet therapy for 1 year after coronary artery bypass grafting in patients with acute coronary syndrome, but considerable variability remains.
  
  
  METHODS
  We performed a survey of 75 Canadian cardiac surgeons to assess the use of dual antiplatelet therapy.
  
  
  RESULTS
  Whereas 58.6% of respondents indicated that the benefits of dual antiplatelet therapy were seen irrespective of how patients were managed after acute coronary syndrome, 36.2% believed that the benefits of dual antiplatelet therapy were limited to those treated medically or percutaneously. In regard to the timing of dual antiplatelet therapy administration, 57% of respondents indicated that dual antiplatelet therapy should be given upstream in the emergency department, whereas 36.2% responded that dual antiplatelet therapy should be given only once the coronary anatomy has been defined. The majority surveyed (81%) weighed bleeding risk as being more important than ischemic risk reduction. In stable patients after acute coronary syndrome, the majority of surgeons would wait approximately 4 days after the last dose of P2Y12 antagonist before coronary artery bypass grafting. Only 44.6% indicated that they routinely use dual antiplatelet therapy postrevascularization in the setting of acute coronary syndrome. Rather, most surgeons use dual antiplatelet therapy for select patients, such as those with a stented vessel without a bypass graft, endarterectomy, or off-pump coronary artery bypass grafting.
  
  
  CONCLUSIONS
  Cardiac surgeons exhibit variation in their attitudes and practice patterns toward dual antiplatelet therapy after coronary artery bypass grafting, and in approximately half of cases, their practice does not adhere to current guideline recommendations. New trials focusing on coronary artery bypass grafting cases in their primary analysis and educational initiatives for surgeons that focus on guideline recommendations may be warranted.
authors.affiliation: Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Bobby
authors.initials: B
authors.lastname: Yanagawa
authors.affiliation: University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Marc
authors.initials: M
authors.lastname: Ruel
authors.affiliation: Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Bonneau
authors.affiliation: Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Myunghyun M
authors.initials: MM
authors.lastname: Lee
authors.affiliation: Division of Cardiac Surgery, McGill University, Montréal, Quebec, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Chung
authors.affiliation: Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Sadek
authors.initials: S
authors.lastname: Al Shouli
authors.affiliation: Division of Cardiovascular Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Fagan
authors.affiliation: Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Abdulwahab
authors.initials: A
authors.lastname: Al Khalifa
authors.affiliation: Division of Cardiac Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: White
authors.affiliation: Division of Cardiovascular Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Yamashita
authors.affiliation: Division of Cardiac Surgery, London Health Sciences Centre, London, Ontario, Canada.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Currie
authors.affiliation: Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Hwee
authors.initials: H
authors.lastname: Teoh
authors.affiliation: Division of Cardiac Surgery, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Holly E M
authors.initials: HE
authors.lastname: Mewhort
authors.affiliation: Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: vermasu@smh.ca.
authors.forename: Subodh
authors.initials: S
authors.lastname: Verma
mesh_terms: D000241:Adenosine / Q000008:administration & dosage / Q000031:analogs & derivatives; D001241:Aspirin / Q000008:administration & dosage; D002170:Canada; D000077144:Clopidogrel; D001026:Coronary Artery Bypass; D004359:Drug Therapy, Combination; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D000077486:Ticagrelor; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine; D001241:Aspirin
keywords: coronary artery bypass grafting; dual antiplatelet; survey