Peri‐operative management of anti‐platelet agents

Background: Increasing numbers of patients treated with anti‐platelet agents are presenting for non‐cardiac surgery. We examined the peri‐operative management of anti‐platelet therapy in patients undergoing elective non‐cardiac surgery and the process by which patients received instructions. Methods: We interviewed and collected outcome data on 213 consecutive patients aged ≥45 years presenting for elective non‐cardiac surgery at our institution over a 6‐week period regarding the peri‐operative management of anti‐platelet and warfarin therapy. Results: Anti‐platelet therapy was prescribed in 22.5% and warfarin in 5.2% of the study subjects. Aspirin was stopped peri‐operatively in 55.3%, while clopidogrel was stopped in the sole patient treated with this. The frequency of anti‐platelet agent discontinuation was similar for major and minor surgery. Warfarin was discontinued prior to surgery in all cases. Only 54.2% of those treated with anti‐platelet therapy recalled being given instruction regarding pre‐operative management of their anti‐platelet therapy compared with 90.9% of patients treated with warfarin (P= 0.04). In the absence of instructions, a number of patients made their own decision to stop their aspirin pre‐operatively. Post‐operatively, only 37% recalled receiving instructions regarding restarting anti‐platelet therapy. As a result, three patients failed to do so. In contrast, all those treated with warfarin received clear post‐operative instructions. Conclusion: Peri‐operative anti‐platelet management and communication with patients appears to be sub‐optimal. There is a need for standardized processes whereby informed decisions regarding peri‐operative anti‐platelet therapy are made and communicated clearly to the patients.