title: A retrospective study showing the extent of compliance with perioperative guidelines in patients with coronary stents with regard to double antiplatelet therapy.
abstract: OBJECTIVE
  To evaluate perioperative dual antiplatelet therapy management in patients with previously placed coronary stents.
  
  
  METHODS
  Retrospective medical record review.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  A total of 1891 surgical cases performed at Vanderbilt University Medical Center in 2012 were evaluated using a perioperative database. Of these, 161 had complete data records that were evaluated using 2 evidence-based and expert opinion-supported protocols.
  
  
  METHODS
  N/A.
  
  
  METHODS
  This study is meant to evaluate perioperative antiplatelet management decisions in patients with coronary stents.
  
  
  RESULTS
  Management decisions were consistent with guidelines regarding antiplatelet therapy in 13% (21/161) of patients. Of the 87% (140/161) of cases where decisions were not consistent, 88% (123/140) were due to discontinuing aspirin preoperatively when there was not a high risk of surgical bleeding.
  
  
  CONCLUSIONS
  This study revealed suboptimal adherence to current perioperative antiplatelet management guidelines in patients with coronary stents. The lack of adherence to current guidelines is concerning and could be used to support the notion of an anesthesiologist-led Perioperative Surgical Home.
authors.affiliation: University of Tennessee Health Science Center, Memphis, TN. Electronic address: awoolard@uthsc.edu.
authors.forename: Austin A
authors.initials: AA
authors.lastname: Woolard
authors.affiliation: Department of Anesthesiology, Vanderbilt University, Nashville, TN; Department of Biomedical Informatics, Vanderbilt University, Nashville, TN; Department of Surgery, Vanderbilt University, Nashville, TN.
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Ehrenfeld
authors.affiliation: Department of Anesthesiology, Vanderbilt University, Nashville, TN.
authors.forename: Susan S
authors.initials: SS
authors.lastname: Eagle
authors.affiliation: Department of Anesthesiology, Vanderbilt University, Nashville, TN; Department of Biomedical Informatics, Vanderbilt University, Nashville, TN.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Wanderer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use; D019090:Case Management; D000077144:Clopidogrel; D003331:Coronary Vessels; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000592:standards* / Q000706:statistics & numerical data; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D015607:Stents; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: Antiplatelet agents; Coronary stents; Dual antiplatelet therapy; Perioperative Surgical Home