Comparative analysis of perioperative management of antiplatelet agent guidelines across US institutions

Cardiovascular disease (CVD) is the leading cause of mortality worldwide, prompting increasing use of antiplatelet agents for primary and secondary prevention. Despite guidelines from multiple professional societies on the perioperative management of antiplatelet agents, we hypothesized that their implementation varies, leading to inconsistencies in perioperative practices across the United States (US).

We surveyed eleven members of the Systems-Based Hematology Committee of the Venous ThromboEmbolism Network US (VENUS) to gather their institutions' guidelines on the perioperative management of antiplatelet agents for non-cardiac surgery. Institutional guidelines were compared with five professional society guidelines.

Of the 11 academic medical centers (AMCs), 8 (72.7 %) had institutional guidelines on perioperative management of antiplatelet agents (aspirin and three P2Y₁₂ inhibitors) prior to non-cardiac surgery. Of the remaining three, two had guidelines on the management of antiplatelet agents prior to interventional radiology procedures (n = 1) and for neuraxial anesthesia (n = 1). Five AMCs gave differing recommendations on managing phosphodiesterase inhibitors perioperatively, while none of the five society guidelines addressed them. Five AMCs provided variable recommendations on the timing of postoperative resumption of antiplatelet agents ranging from as soon as possible to 12-24 h postoperatively depending on bleeding risk. Only two AMCs provided recommendations for those on antiplatelet agents who have life-threatening peri-operative bleeding or undergoing urgent high-bleeding risk surgery.

AMCs vary in their recommendations on the perioperative management of antiplatelet agents prior to non-cardiac surgery. Further research is needed to determine if this variability impacts patient outcomes and to identify ways to improve guideline implementation.