ABSTRACT:

Objective: The perioperative management of antiplatelet agents (APA) in coronary patients remains a challenge for anesthesiologists and cardiologists due to the delicate balance between bleeding and thrombotic risks. This study aimed to assess current practices at CHU IBN ROCHD in Casablanca.
Methods: A cross-sectional observational study was conducted between September and December 2023 among anesthesiologists and cardiologists, using an electronic questionnaire. Data were analyzed descriptively using R Studio software.
Results: Among 93 participants (54% anesthesiologists, 46% cardiologists), wide variability in practice was observed. Most anesthesiologists discontinued aspirin even in self-medication cases, whereas cardiologists favored a more individualized approach. Management of patients under dual antiplatelet therapy (DAPT) was inconsistent, especially in emergency surgery settings. Specialist consultation was reported in only 54% of cases by anesthesiologists.
Conclusion: This study highlights the lack of consensus and the urgent need for interdisciplinary coordination and locally adapted protocols to improve perioperative safety in patients receiving antiplatelet therapy.

KEYWORDS :

Perioperative management; Antiplatelet agents; Aspirin; Dual antiplatelet therapy; Cardiovascular risk.

REFERENCES :

1) Rossini R, et al. Management of antiplatelet therapy in patients undergoing surgery. Eur Heart J. 2020;41(5):450-457.
2) Valgimigli M, et al. 2023 ESC Guidelines on cardiovascular disease in non-cardiac surgery. Eur Heart J. 2023;44(31):2640–2704.
3) Godier A, et al. Gestion des agents antiplaquettaires pour une procédure invasive programmée. Anesth Réanim. 2018;4(6):548–62.
4) Douketis JD, et al. Perioperative management of antithrombotic therapy. Chest. 2012;141(2_suppl):e326S-e350S.
5) Ferraris VA, et al. 2012 Update to the Society of Thoracic Surgeons Guideline on Antiplatelet Therapy. Ann Thorac Surg. 2012;94(5):1761–81.
6) Windecker S, et al. Antiplatelet therapy for PCI in patients at high bleeding risk. Eur Heart J. 2017;38(34):2739–49.
7) Capodanno D, et al. DAPT in clinical practice: balancing ischemic and bleeding risks. J Am Coll Cardiol. 2017;70(6):728–48. 
8) Sibbing D, et al. Antiplatelet therapy and platelet function testing. Circulation. 2015;131(5):456–69.
9) Levine GN, et al. 2016 ACC/AHA Update on Dual Antiplatelet Therapy. Circulation. 2016;134(10):e123–55.
10) De Caterina R, et al. Thrombosis risk and antiplatelet therapy before non-cardiac surgery. J Thromb Haemost. 2015;13(11):2022–36.