Coronary stents and subsequent surgery: reported provider attitudes and practice patterns

Area of Science:

• Cardiology
• Surgical Management
• Pharmacology

Background:

• Managing antiplatelet therapy in patients with cardiac stents undergoing non-cardiac surgery presents significant challenges.
• Current guidelines suggest delaying elective surgery or proceeding without aspirin cessation for emergent procedures.

Purpose of the Study:

• To assess provider knowledge, attitudes, and practices regarding antiplatelet therapy management in patients with cardiac stents requiring subsequent surgery.
• To identify variations in practice patterns among different medical specialists.

Main Methods:

• A national survey was conducted among Veterans Administration surgeons, anesthesiologists, and cardiologists.
• Data collected included guideline awareness, agreement, perceptions of bleeding risk and stent thrombosis, and practice patterns.
• Statistical analyses included Chi-square tests and generalized estimating equations to identify practice variations.

Main Results:

• High guideline awareness (92%) and agreement (93%) were reported, particularly among cardiologists and anesthesiologists compared to surgeons.
• Provider type significantly influenced antiplatelet therapy management, with cardiologists and anesthesiologists more likely to continue dual therapy for early surgeries.
• Personal experience with stent thrombosis was associated with reported practice patterns.

Conclusions:

• Despite widespread guideline adoption, significant variations in antiplatelet management practices exist among surgeons, anesthesiologists, and cardiologists.
• Further research is needed to understand the reasons for these variations and to optimize perioperative care for patients with coronary stents undergoing non-cardiac surgery.