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

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

3. AIM… to prevent…!
Acute thrombosis of SVG

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

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

7. 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

8. 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)

11. 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?

12. 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.

13. HOW CAN WE IMPROVE?

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

16. 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?

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

18. REFERENCES
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Bong Gun Song, Hyun Suk Yang, Joon Hyung Doh, Hong Jang, Gu Hyun Kang, Yong Hwan Park, Woo Jung Chun, Ju Hyeon Oh, Sung Min Ko and Hweung Kon Hwang (2011). Assessment of Coronary Artery Bypass Graft (CABG) Patency and Graft Disease Using Multidetector Computed Tomography (MDCT), Coronary Angiography - Advances in Noninvasive Imaging Approach for Evaluation of Coronary Artery Disease, Prof. Baskot Branislav (Ed.), InTech, DOI: / Available from: coronary-artery-bypass-graft-cabg-patency-and-graft-disease-using-multidetector-comput
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