The perioperative management of patients with coronary artery stents: surveying the clinical stakeholders and arriving at a consensus regarding optimal care

• Published in: The American journal of surgery 2012-10, Vol.204 (4), p.453-461.e2
• Main Authors: Vetter, Thomas R., M.D., M.P.H, Boudreaux, Arthur M., M.D, Papapietro, Silvio E., M.D, Smith, Perry W., M.D, Taylor, Benjamin B., M.D., M.P.H, Porterfield, John R., M.D., M.S.P.H
• Format: Article
• Language: English
• Subjects: Adult; Advisory Committees; Agreements; Alabama; Anesthesiology; Anesthesiology - manpower; Antiplatelet therapy; Aspirin - administration & dosage; Aspirin - adverse effects; Biological and medical sciences; Blood Loss, Surgical - prevention & control; Cardiac Catheterization; Cardiology; Cardiology - manpower; Chi-square test; Consensus; Consensus decision making; Coronary artery stent; Coronary Vessels; Cross-Sectional Studies; Decision Making; Decision Support Techniques; Female; General aspects; General Surgery - manpower; Health Care Surveys; Humans; Male; Medical sciences; Middle Aged; Myocardial Ischemia - prevention & control; Perioperative Care - methods; Perioperative management; Perioperative Period; Physicians - statistics & numerical data; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - adverse effects; Primary care; Primary Health Care - manpower; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Risk Factors; Sampling Studies; Stents; Stents - adverse effects; Surgery; Surveys and Questionnaires; Thrombosis; Thrombosis - etiology; Thrombosis - prevention & control; Ticlopidine - administration & dosage; Ticlopidine - adverse effects; Ticlopidine - analogs & derivatives
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2012.02.012

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.