A retrospective study showing the extent of compliance with perioperative guidelines in patients with coronary stents with regard to double antiplatelet therapy

•We evaluated perioperative antiplatelet management in patients with coronary stents.•We found that the majority of decisions were inconsistent with current guidelines.•Most variant decisions involved discontinuing aspirin preoperatively.

Study objectiveTo evaluate perioperative dual antiplatelet therapy management in patients with previously placed coronary stents.DesignRetrospective medical record review.SettingAcademic medical center.PatientsA total of 1891 surgical cases performed at Vanderbilt University Medical Center in 2012 were evaluated using a perioperative database. Of these, 161 had complete data records that were evaluated using 2 evidence-based and expert opinion–supported protocols.InterventionsN/A.MeasurementsThis study is meant to evaluate perioperative antiplatelet management decisions in patients with coronary stents.Main resultsManagement decisions were consistent with guidelines regarding antiplatelet therapy in 13% (21/161) of patients. Of the 87% (140/161) of cases where decisions were not consistent, 88% (123/140) were due to discontinuing aspirin preoperatively when there was not a high risk of surgical bleeding.ConclusionsThis study revealed suboptimal adherence to current perioperative antiplatelet management guidelines in patients with coronary stents. The lack of adherence to current guidelines is concerning and could be used to support the notion of an anesthesiologist-led Perioperative Surgical Home.