Post-operative antiplatelet therapy following coronary artery bypass graft surgery Rory Kelleher, Josephine Mak, David J McCormack, Adam El Gamel Waikato Cardiothoracic Unit

BACKGROUND saphenous vein most common in CABG early graft failure - thrombosis DAPT improves prognosis Benefits: prevents graft closure Risks: bleeding

AIM… to prevent…! Acute thrombosis of SVG

CURRENT recommendations 2016 ACC/AHA GUIDLINE - aspirin and clopidogrel should be continued in ACS & SIHD patients for one year postoperatively

AIM to evaluate the received postoperative antiplatelet therapy of CABG patients at discharge

METHODS 3 months of post-cabg patients (Jan-March 2016) 69 patients patients on anticoagulant therapy excluded discharge summaries analysed antiplatelet medications prescribed duration of proposed antiplatelet therapy

RESULTS DAPT on discharge summaries was markedly varied 17 different regimens were found Varying length of therapy and agents most common regimen: 3 months aspirin & 3 months clopidogrel (27 patients) No pattern in prescribing when patients separated according to preoperative status (ACS, SIDH or PCI)

DISCUSSION cardiology 6 weeks post-op, meds changed? Max length prescription 3 months duration should be in discharge plan Should be clearly documented by the cardiothoracic team GPs and cardiologists Rely too heavily on cardiologists? Need for a protocol?

conclusion DAPT not being documented appropriately at discharge Requirement for an intervention Applying best practice may help future research to compare the efficacy of percutaneous stents with CABG.

HOW CAN WE IMPROVE?

Solution? postoperative antiplatelet card issued to patients listing the current guidelines, antiplatelet prescribed and the rationale for choosing this regimen. Promotes patient empowerment

Future research Closed loop audit – repeat 3 months following intervention Are cardiologists changing antiplatelets at 6 weeks? Contact gp’s – are patients still on antiplatelets at 12 months?

Cardiologists AND CT surgeons – team. not one or the other. Update guidelines Implement change Educate staff Improve care

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