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 > or = 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.
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http://dx.doi.org/10.1111/j.1445-2197.2009.04981.x | DOI Listing |
Cardiovasc Revasc Med
December 2024
Veterans Affairs Boston Healthcare System, West Roxbury, MA, United States of America; Brigham and Women's Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America. Electronic address:
Introduction: Older patients may be denied endovascular revascularization of the superficial femoral artery (SFA) for peripheral artery disease (PAD) due to concerns of worse limb outcomes than younger patients.
Methods: We assessed adverse outcomes in patients after an index revascularization stratified by age (age < 65, 65-75 years, and > 75 years) from two centers between 2003 and 2011 and followed a median 9 (25 %-75 %: 7, 11) years. Outcomes included major adverse limb events (MALE) or minor repeat revascularization, death, and major adverse cardiac and cerebrovascular events (MACCE).
Nutrients
December 2024
Department of Emergency Medicine, Natural and Biomimetic Medicine Research Center, Tissue-Orientated Property of Chinese Medicine Key Laboratory of Sichuan Province, West China School of Medicine, West China Hospital, Sichuan University, Chengdu 610000, China.
Background: Radix Paeoniae Rubra (RPR), an edible and medicinal Traditional Chinese Medicine (TCM), is extensively employed in therapeutic interventions of cardiovascular and cerebrovascular diseases. However, the curative effect of RPR on ischemic stroke remains ambiguous. This work integrated network pharmacology, molecular docking, and experimental validation to explore the mechanisms of RPR in treating ischemic stroke.
View Article and Find Full Text PDFMedicina (Kaunas)
December 2024
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
Percutaneous coronary intervention (PCI) is a proven therapy for acute myocardial infarction (AMI) cardiogenic shock (CS). Dual anti-platelet therapy (i.e.
View Article and Find Full Text PDFJVS Vasc Insights
January 2024
Manchester Vascular Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, United Kingdom.
Objective: Lower extremity arterial disease (LEAD) is a prevalent condition that produces a significant burden on health care systems. Patients with LEAD have an increased risk of major adverse cardiovascular events as well as major adverse limb events. Despite significant variation in guidance on antiplatelet therapy for LEAD worldwide, many governing bodies recommend clopidogrel as the preferred single anti-platelet agent.
View Article and Find Full Text PDFBackground: Current guidelines lack recommendations regarding the use of proton pump inhibitors (PPIs) for preventing upper gastrointestinal bleeding (UGIB) among patients at low risk for UGIB treated with dual antiplatelet therapy for ischemic stroke (IS). Our objective was to assess the effectiveness of PPIs in lowering the risk of significant UGIB in this patient group.
Methods And Results: A retrospective cohort study was conducted involving patients at low risk for UGIB admitted for IS between 2014 and 2018 and treated with dual antiplatelet therapy.
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