BACKGROUND:International guidelines do not provide uniform recommendations regarding the use of antiplatelet treatment in the perioperative period in patients undergoing coronary artery bypass grafting (CABG). METHODS:A questionnaire was sent to all 16 cardiothoracic centres in the Netherlands to determine which antiplatelet treatment is used in the perioperative setting. Furthermore, a single-centre prospective observational cohort study was performed which included all patients undergoing isolated CABG in July 2014. RESULTS:Eleven centres responded to the survey. Acetylsalicylic acid monotherapy was discontinued before surgery in 6 centres. In patients with an acute coronary syndrome receiving dual antiplatelet therapy (DAPT), most centres discontinued the P2Y12 inhibitor preoperatively. DAPT was restarted after surgery in 4 centres. However, 6 centres continued DAPT in patients who had undergone coronary stenting within one month of surgery. In patients with coronary stents, variation in the management of antiplatelet therapy increased in proportion to the interval between stenting and surgery. A total of 70 patients were included in the registry. Acetylsalicylic acid monotherapy was discontinued in 51% of patients and restarted in all patients. P2Y12 inhibitor treatment was discontinued before surgery in 70% of patients and re-initiated after CABG in 29%. CONCLUSIONS:Major differences were observed in the preoperative and postoperative management of antiplatelet treatment between different Dutch cardiothoracic centres and within a single centre. Part of this variation is probably due to lack of evidence and differences between the current guidelines; however, many of the strategies were not in accordance with any of these guidelines.

译文

背景:国际指南并未就接受冠状动脉旁路移植术(CABG)的患者在围手术期使用抗血小板治疗提供统一的建议。
方法:将问卷调查表发送到荷兰的所有16个心电图中心,以确定围手术期使用哪种抗血小板治疗。此外,2014年7月进行了一项单中心前瞻性观察队列研究,其中包括所有接受孤立CABG的患者。
结果:11个中心对调查进行了答复。手术前6中心停用乙酰水杨酸单药治疗。在接受双重抗血小板治疗(DAPT)的急性冠状动脉综合征患者中,大多数中心在术前停用P2Y12抑制剂。在4个中心手术后,DAPT重新开始。但是,在手术后一个月内接受冠状动脉支架置入术的患者中,有6个中心继续进行DAPT。在冠状动脉支架患者中,抗血小板治疗管理的差异与支架置入和手术间隔的比例成正比。注册表中总共包括70名患者。乙酰水杨酸单药治疗在51%的患者中终止,并在所有患者中重新开始。 70%的患者在手术前中断了P2Y12抑制剂治疗,而29%的患者在CABG后重新开始治疗。
结论:在荷兰不同的心胸中心之间和单个中心内,在抗血小板治疗的术前和术后处理中观察到主要差异。这种变化的部分原因可能是由于缺乏证据以及当前准则之间的差异;但是,许多策略都不符合这些准则中的任何一项。

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