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When do vascular surgeons prescribe antiplatelet therapy? Current attitudes
S Sarin1, S K Shami, T R Cheatle
1Department of Surgery, University College & Middlesex School of Medicine, Middlesex Hospital, London, U.K.
Insights
Antiplatelet therapy effectively prevents secondary atherosclerotic events. Routine use is recommended for patients with arterial disease, regardless of surgical intervention, to reduce long-term vascular mortality and events.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Pharmacology
Background:
- Antiplatelet agents are crucial for preventing atherosclerotic events.
- Evidence supports their use in secondary prevention for conditions like unstable angina and myocardial infarction.
- Benefit in preventing vascular graft occlusion requires further investigation.
Purpose of the Study:
- To review existing literature on antiplatelet therapy efficacy.
- To assess current practices of vascular surgeons regarding antiplatelet use.
- To provide recommendations on routine antiplatelet prescription in arterial disease.
Main Methods:
- Literature review on antiplatelet therapy in atherosclerotic event prevention.
- Postal survey of Vascular Surgeons in Britain and Ireland.
- Analysis of 112 responses regarding antiplatelet drug usage post-vascular procedures.
Main Results:
- Strong evidence supports routine antiplatelet therapy for secondary atherosclerotic event prevention.
- 47% of surveyed surgeons routinely used antiplatelet therapy post-vascular procedures.
- Selective use was noted for specific reconstructions (e.g., synthetic grafts) and post-angioplasty.
Conclusions:
- Routine antiplatelet therapy is strongly advocated for patients with arterial disease presenting to vascular surgeons.
- This recommendation applies irrespective of the type of vascular reconstruction, angioplasty, or graft used.
- Widespread adoption could reduce long-term vascular mortality and non-fatal vascular events.
Abstract:
A large number of studies have addressed the efficacy of antiplatelet agents in the prevention of primary and secondary atherosclerotic events. We have undertaken to review the literature and conclude that there is good evidence for the routine prescription of antiplatelet therapy in the prevention of secondary atherosclerotic events in patients with unstable angina, myocardial infarction, transient ischaemic attacks and post-arterial reconstruction. The evidence for any benefit in the prevention of vascular graft occlusion is less clear cut. We therefore conducted a postal survey of Vascular Surgeons in Britain and Ireland, receiving 112 responses to 134 questionnaires. Forty-seven percent of surgeons used antiplatelet therapy following any vascular procedure that they undertook. The rest were more selective in their use of these drugs, reserving them for specific vascular reconstruction, e.g. with synthetic grafts. Five percent of surgeons used anti-platelet aggregating prophylaxis only in patients following transluminal balloon angioplasty. In view of extensive evidence of reduction in long-term vascular mortality and non-fatal vascular events by the use of these drugs in patients who have had a primary vascular event, we would suggest that there is a strong argument for the routine use of anti-platelet drugs in patients presenting with arterial disease to a Vascular Surgeon, regardless of vascular reconstruction, angioplasty or type of graft used.