Consensus decision-making for the management of antiplatelet therapy before non-cardiac surgery in patients who underwent percutaneous coronary intervention with second-generation drug-eluting stents: A cohort study

Choongki Kim, Jung Sun Kim, Hyeongsoo Kim, Sung Gyun Ahn, Sungsoo Cho, Oh Hyun Lee, Jong Kwan Park, Sanghoon Shin, Jae Youn Moon, Hoyoun Won, Yongsung Suh, Jung Rae Cho, Yun Hyeong Cho, Seung Jin Oh, Byoung Kwon Lee, Sung Jin Hong, Dong Ho Shin, Chul Min Ahn, Byeong Keuk Kim, Young Guk KoDonghoon Choi, Myeong Ki Hong, Yangsoo Jang

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Although antiplatelet therapy (APT) has been recommended to balance ischemic-bleeding risks, it has been left to an individualized decision-making based on physicians’ perspectives before non-cardiac surgery. The study aimed to assess the advantages of a consensus among physicians, surgeons, and anesthesiologists on continuation and regimen of preoperative APT in patients with coronary drug-eluting stents. METHODS AND RESULTS: A total of 3582 adult patients undergoing non-cardiac surgery after percutaneous coronary intervention with second-generation stents was retrospectively included from a multicenter cohort. Physicians determined whether APT should be continued or discontinued for a recommended period before non-cardiac surgery. There were 3103 patients who complied with a consensus decision. Arbitrary APT, not based on a consensus decision, was associated with urgent surgery, high bleeding risk of surgery, female sex, and dual APT at the time of preoperative evaluation. Arbitrary APT independently increased the net clinical adverse event (adjusted odds ratio [ORadj ], 1.98; 95% CI, 1.98–3.11), major adverse cardiac event (ORadj, 3.11; 95% CI, 1.31–7.34), and major bleeding (ORadj, 2.34; 95% CI, 1.45–3.76) risks. The association was consistently noted, irrespective of the surgical risks, recommendations, and practice on discontinuation of APT. CONCLUSIONS: Most patients were treated in agreement with a consensus decision about preoperative APT based on a referral system among physicians, surgeons, and anesthesiologists. The risk of perioperative adverse events increased if complying with a consensus decision was failed. REGISTRATION: URL: https://www.clini​caltr​ials.gov; Unique identifier: NCT03908463.

Original languageEnglish
Article numbere020079
JournalJournal of the American Heart Association
Volume10
Issue number8
DOIs
Publication statusPublished - 2021

Bibliographical note

Funding Information:
This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute, funded by the Ministry of Health & Welfare, Republic of Korea (No: HI15C1277), a grant from the National Research Foundation of Korea grant, funded by the Korean Government (No. 2017R1A2B2003191), the Ministry of Science & ICT (2017M3A9E9073585), and the Cardiovascular Research Center (Seoul, Korea).

Publisher Copyright:
© 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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