Abstract P143: Drug-Eluting Stents and Noncardiac Surgery: VA Provider Perioperative Practice Based on Guideline Agreement and Experience with Stent Thrombosis
Authors: Maddox Thomas M , Graham Laura A , Hawn Mary T 
Published: July 2021

Background
Though guidelines for anti-platelet therapy in patients undergoing non-cardiac surgery in the year following drug-eluting stent (DES) placement exist, optimal management of these patients is unknown. Possible influences on provider practice include agreement with guidelines and personal experience with patients who have experienced stent thrombosis. We assessed these influences among VA providers' practices of anti-platelet use in DES patients with cardiac stents needing surgery in the subsequent year.

Methods
A national web-based survey was administered to VA cardiologists, surgeons, and anesthesiologists. The survey was distributed by the respective national directors via email. Responses were collected and compared with chi-square tests.

Results
297 providers from 80 separate medical centers responded to the survey. Of these, 107 (36.0%) were cardiologists, 88 (29.6%) surgeons, and 92 (31.0%) anesthesiologists. In general, surgeons were less likely than cardiologists or anesthesiologists to continue dual anti-platelet therapy in the peri-operative period (Table 1). Agreement with guidelines did not significant affect these provider dual anti-platelet therapy practices, but personal experience with patients experiencing stent thrombosis increased surgeons' rates of dual anti-platelet therapy use by over 25% (Table 2).

Conclusions
Significant variation by provider in anti-platelet management among DES patients exists, which is partially mediated by personal experience with stent thrombosis. This variation points to the need for further clarity in optimal treatment, and the impact of personal experience on management decisions.

Dual Anti-Platelet Practices in the Peri-Operative Period Among VA Providers

Overall (N = 297)
Cardiologists (N =107)
Surgeons (N = 88)
Anesthesiologists (N = 92)
Other Providers (N = 10)
P-value

Continue dual antiplatelet therapy
214 (72.1%)
81 (75.7%)
53 (60.2%)
73 (79.4%)
7 (70%)
0.03

Continue aspirin only or stop all
83 (28%)
26 (24.3%)
35 (39.8%)
19 (20.7%)
3 (30%)

Dual Anti-Platelet Practices by Guideline Agreement and Stent Thrombosis Experience

Overall (N = 297)
Cardiologists (N = 107)
Surgeons (N = 88)
Anesthesiologists (N = 92)

Agree with Guidelines
Disagree with Guidelines
Agree with Guidelines
Disagree with Guidelines
Agree with Guidelines
Disagree with Guidelines
Agree with Guidelines
Disagree with Guidelines

Continue dual antiplatelet therapy
180 (73.5%)
34 (65.4%)
73 (74.5%)
8 (88.9%)
35 (61.4%)
18 (58.1%)
65 (80.3%)
8 (72.7%)

Continue aspirin only or stop all
65 (26.5%)
18 (34.6%)
25 (25.5%)
1 (11.1%)
22 (38.6%)
13 (41.9%)
16 (19.8%)
3 (27.3%)

Overall (N = 289)
Cardiologists (N = 106)
Surgeons (N = 84)
Anesthesiologists (N = 92)

Experience with Stent Thrombosis
No Experience with Stent Thrombosis
Experience with Stent Thrombosis
No Experience with Stent Thrombosis
Experience with Stent Thrombosis
No Experience with Stent Thrombosis
Experience with Stent Thrombosis
No Experience with Stent Thrombosis

Continue dual antiplatelet therapy
78 (78%)
130 (68.8%)
45 (79%)
35 (71.4%)

14 (82.4%)
*

37 (55.2%)
*

17 (73.9%)
56 (81.2%)

Continue aspirin only or stop all
22 (22%)
59 (31.2%)
12 (21.1%)
14 (28.6%)
3 (17.7%)
30 (44.8%)
6 (26.1%)
13 (18.8%)

*

P-value = 0.05