Perioperative Management of Antiplatelets and Anticoagulants in Elective Surgery
ISTH Academy. Sindone J. Jul 9, 2019; 264673; PB1483
James Sindone
James Sindone
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Perioperative Management of Antiplatelets and Anticoagulants in Elective Surgery

J. Sindone1,2, R. Day3,4, M. Stefani3, J. Joseph3
1University of New South Wales, Medicine, Sydney, Australia, 2St Vincent's Hospital, Clinical Pharmacology and Toxicology, Sydney, Australia, 3St Vincent's Hospital, Sydney, Australia, 4University of New South Wales, Sydney, Australia

Main Topic: Hemophilia and Bleeding (including Transfusion)
Category: Management of Bleeding & Trauma

Background: Significant proportions of the population are prescribed anticoagulants or antiplatelets to prevent cardiovascular events. In 2017, the Clinical Excellence Commission (CEC) developed Guidelines for perioperative management of elective surgery patients on anticoagulants. In 2016, the European Society of Cardiology (ESC) developed Guidelines for antiplatelet medicines. Subsequently, CEC guidelines on antiplatelets have also been published, however these were published prior to the study period. Current practice and concordance with these guidelines is unknown.
Aims: To evaluate:
(i) perioperative management of patients taking anticoagulants and antiplatelets;
(ii) concordance with Guideline recommendations; and
(iii) bleeding, thrombosis and rehospitalisation rates.
Methods: Retrospective analysis of consecutive adults undergoing elective surgery at St. Vincent's Hospital from 01/01/17-30/04/18 who received anticoagulants or antiplatelets pre-operatively. Concordance with guidelines was rated according to thrombosis and bleeding risk tables and cofactors.
Anticoagulants: Studied 145 patients, age 72±10.7 years. Interruption/bridging anticoagulation was guideline concordant in 140 cases (96.6%). Thromboembolism occurred in 3 patients (2.1%), 31 required blood transfusion (21.4%) and 5 rehospitalisation for bleeding or thromboembolism (3.4%). Bridging was performed in 35 patients (24%), of whom 10 (28.5%) required transfusion. Only 18 (16.4%) non-bridged patients were transfused. Appropriate interruption/bridging was associated with fewer transfusions (p=0.04).
Antiplatelets: Evaluated 182 patients, age 69.4±11.6 years. Interruption/continuing antiplatelets was guideline concordant in 139 patients (76.4%), whilst duration of cessation was concordant in 48 (26.4%). Thromboembolism occurred in 2 (1.1%), transfusion in 32 (17.6%), with 14 (7.7%) hospitalised within three months for bleeding or thromboembolism.
Conclusions: There is widespread variance in perioperative management of anticoagulant and antiplatelet medications, particularly in duration of antiplatelet cessation, with high levels of non-concordance negatively impacting patient outcomes.

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