Current perioperative management of antiplatelet use in patients undergoing elective non-cardiac surgery in a university hospital
Background & Objectives: As the population ages, more elderly patients who tend to have cardiovascular diseases are undergoing surgery. Antiplatelet agents which are the essential component of the treatment of these comorbidities increase bleeding risk. Optimal management of perioperative antiplatelet therapy, balancing ischemic and bleeding risk, has been discussed and documented in several guidelines recently. The purpose of this study is to describe the change of clinical characteristics and perioperative antiplatelet management in the recent 4 years in a large metropolitan university hospital.
Materials & Methods: The authors retrospectively analyzed data collected in our Anesthesia Information Management Systems (PrimeGaia, Nihon Koden, Japan) between January 2013 and December 2016 in a large metropolitan university hospital in Japan. Patients under 40 years old, cardiac surgery, dental surgery and emergency cases were excluded. Data included the use of antiplatelet, coexisting thrombotic complications, type of previous percutaneous coronary intervention (PCI), surgical and anesthetic procedures, and the amount of bleeding during the surgery. Group differences were evaluated using Chi-square test, test for trend or Student’s t-test, as appropriate.
Results: In 16,628 elective non-cardiac surgeries, 1,903 (11.4%) patients received antiplatelet therapy. The rates of ischemic heart disease (5.9%) and stroke (6.0%) did not change over the 4-year study period, and neither did the proportion of patients who were on antiplatelet. However, cases continuing perioperative antiplatelet therapy increased with years (2013: n=105/422 (25%), 2014: n=154/485 (32%), 2015: n=214/476 (45%), and 2016: n=230/520 (44%), P < 0.01). The use of local anesthesia slightly decreased (49.5%, 47.8%, 47.8% and 46.9%, respectively, P = 0.052). There was no significant difference in surgical bleeding between continued cases and discontinued cases (187 ± 373 mL vs 202 ± 490 mL, P = 0.47). 
Conclusion: In the present study, we found that perioperative continuation of antiplatelet therapy increased year by year in our hospital, which may be due to the shift of PCI technique from bare metal stent to drug eluting stent, and may be a reflection of the guidelines. The continuation of antiplatelet did not significantly increase the surgical bleeding in this study. Further analysis is needed to evaluate the perioperative adverse event and the inherent bleeding risk depending on certain procedures.