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

Academic Article

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.
  • Published In

    Keywords

  • Adult, Advisory Committees, Alabama, Anesthesiology, Aspirin, Blood Loss, Surgical, Cardiac Catheterization, Cardiology, Clopidogrel, Consensus, Coronary Vessels, Cross-Sectional Studies, Decision Making, Decision Support Techniques, Female, General Surgery, Health Care Surveys, Humans, Male, Middle Aged, Myocardial Ischemia, Perioperative Care, Perioperative Period, Physicians, Platelet Aggregation Inhibitors, Primary Health Care, Risk Factors, Sampling Studies, Stents, Surveys and Questionnaires, Thrombosis, Ticlopidine, Workforce
  • Digital Object Identifier (doi)

    Authorlist

  • Vetter TR; Boudreaux AM; Papapietro SE; Smith PW; Taylor BB; Porterfield JR
  • Start Page

  • 453
  • End Page

  • 461.e2
  • Volume

  • 204
  • Issue

  • 4