Bobby Yanagawa1, Marc Ruel2, Christopher Bonneau1, Myunghyun M Lee1, Jennifer Chung3, Sadek Al Shouli4, Andrew Fagan5, Abdulwahab Al Khalifa1, Christopher W White6, Michael H Yamashita7, Maria E Currie8, Hwee Teoh9, Holly E M Mewhort10, Subodh Verma11. 1. Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. 2. University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada. 3. Division of Cardiac Surgery, McGill University, Montréal, Quebec, Canada. 4. Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada. 5. Division of Cardiovascular Surgery, Dalhousie University, Halifax, Nova Scotia, Canada. 6. Division of Cardiac Surgery, University of Manitoba, Winnipeg, Manitoba, Canada. 7. Division of Cardiovascular Surgery, University of British Columbia, Vancouver, British Columbia, Canada. 8. Division of Cardiac Surgery, London Health Sciences Centre, London, Ontario, Canada. 9. Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, St Michael's Hospital, Toronto, Ontario, Canada. 10. Division of Cardiac Surgery, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada. 11. Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: vermasu@smh.ca.
Abstract
BACKGROUND: Dual antiplatelet therapy is the cornerstone treatment for patients with acute coronary syndrome. Recent Canadian Guidelines recommend the use of dual antiplatelet therapy for 1 year after coronary artery bypass grafting in patients with acute coronary syndrome, but considerable variability remains. METHODS: We performed a survey of 75 Canadian cardiac surgeons to assess the use of dual antiplatelet therapy. RESULTS: Whereas 58.6% of respondents indicated that the benefits of dual antiplatelet therapy were seen irrespective of how patients were managed after acute coronary syndrome, 36.2% believed that the benefits of dual antiplatelet therapy were limited to those treated medically or percutaneously. In regard to the timing of dual antiplatelet therapy administration, 57% of respondents indicated that dual antiplatelet therapy should be given upstream in the emergency department, whereas 36.2% responded that dual antiplatelet therapy should be given only once the coronary anatomy has been defined. The majority surveyed (81%) weighed bleeding risk as being more important than ischemic risk reduction. In stable patients after acute coronary syndrome, the majority of surgeons would wait approximately 4 days after the last dose of P2Y12 antagonist before coronary artery bypass grafting. Only 44.6% indicated that they routinely use dual antiplatelet therapy postrevascularization in the setting of acute coronary syndrome. Rather, most surgeons use dual antiplatelet therapy for select patients, such as those with a stented vessel without a bypass graft, endarterectomy, or off-pump coronary artery bypass grafting. CONCLUSIONS: Cardiac surgeons exhibit variation in their attitudes and practice patterns toward dual antiplatelet therapy after coronary artery bypass grafting, and in approximately half of cases, their practice does not adhere to current guideline recommendations. New trials focusing on coronary artery bypass grafting cases in their primary analysis and educational initiatives for surgeons that focus on guideline recommendations may be warranted.
BACKGROUND: Dual antiplatelet therapy is the cornerstone treatment for patients with acute coronary syndrome. Recent Canadian Guidelines recommend the use of dual antiplatelet therapy for 1 year after coronary artery bypass grafting in patients with acute coronary syndrome, but considerable variability remains. METHODS: We performed a survey of 75 Canadian cardiac surgeons to assess the use of dual antiplatelet therapy. RESULTS: Whereas 58.6% of respondents indicated that the benefits of dual antiplatelet therapy were seen irrespective of how patients were managed after acute coronary syndrome, 36.2% believed that the benefits of dual antiplatelet therapy were limited to those treated medically or percutaneously. In regard to the timing of dual antiplatelet therapy administration, 57% of respondents indicated that dual antiplatelet therapy should be given upstream in the emergency department, whereas 36.2% responded that dual antiplatelet therapy should be given only once the coronary anatomy has been defined. The majority surveyed (81%) weighed bleeding risk as being more important than ischemic risk reduction. In stable patients after acute coronary syndrome, the majority of surgeons would wait approximately 4 days after the last dose of P2Y12 antagonist before coronary artery bypass grafting. Only 44.6% indicated that they routinely use dual antiplatelet therapy postrevascularization in the setting of acute coronary syndrome. Rather, most surgeons use dual antiplatelet therapy for select patients, such as those with a stented vessel without a bypass graft, endarterectomy, or off-pump coronary artery bypass grafting. CONCLUSIONS: Cardiac surgeons exhibit variation in their attitudes and practice patterns toward dual antiplatelet therapy after coronary artery bypass grafting, and in approximately half of cases, their practice does not adhere to current guideline recommendations. New trials focusing on coronary artery bypass grafting cases in their primary analysis and educational initiatives for surgeons that focus on guideline recommendations may be warranted.
Authors: Jared P Beller; William Z Chancellor; J Hunter Mehaffey; Robert B Hawkins; Matthew R Byler; Alan M Speir; Mohammed A Quader; Andy C Kiser; Leora T Yarboro; Gorav Ailawadi; Nicholas R Teman Journal: Ann Thorac Surg Date: 2020-02-11 Impact factor: 4.330
Authors: Erik Björklund; Carl Johan Malm; Susanne J Nielsen; Emma C Hansson; Hans Tygesen; Birgitta S Romlin; Andreas Martinsson; Elmir Omerovic; Aldina Pivodic; Anders Jeppsson Journal: JAMA Netw Open Date: 2021-08-02