ORIGINAL ARTICLES  VASCULAR SECTION 

The Journal of Cardiovascular Surgery 2015 February;56(1):119-25

Copyright © 2015 EDIZIONI MINERVA MEDICA

lingua: Inglese

Perioperative prophylactic antithrombotic strategies in vascular surgery: current practice in the Netherlands

Wiersema A. ¹, Bruijninckx C. ², Reijnen M. ³, Vos J. ⁴, Van Delden O. ⁵, Vahl A. ⁶, Zeebregts C. ⁷, Moll F. ⁸ ✉

¹ Department of Surgery, Westfriesgasthuis Hoorn, The Netherlands; ² Department of Surgery, Equipe Zorg Bedrijven, Rotterdam, The Netherlands; ³ Department of Surgery, Rijnstate Hospital Arnhem, The Netherlands; ⁴ Department of Radiology, Division of Interventional Radiology, St Antonius Hospital, Nieuwegein, The Netherlands; ⁵ Department of Radiology, Division of Interventional Radiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; ⁶ Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis,Amsterdam, The Netherlands; ⁷ Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; ⁸ Department of Surgery, Division of Vascular Surgery, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands

AIM: The aim of this study was to evaluate the current practice of the use of perioperative antithrombotic drugs to prevent arterial thrombo-embolic complications during arterial vascular surgery by Dutch vascular surgeons. Aim was also to compare the results with the literature and to evaluate the effect of guidelines.
METHODS: A comprehensive questionnaire was sent to all Dutch vascular surgeons performing arterial reconstructive surgery.
RESULTS: The response rate was 84%. Acetylsalicylic acid (ASA) was continued perioperatively by most surgeons (91%). Clopidogrel was discontinued by the majority of respondents (65%). During operation 97% of surgeons administered unfractionated heparin (UFH) before arterial clamping. A minority (11%) measures peroperatively anticoagulant activity in patients’ blood. After infrainguinal venous bypass most surgeons (81%) preferred monotherapy with vitamin K antagonists (VKA), in agreement with the Dutch guideline in this respect. Before the introduction of the guideline in 2005, a survey was performed in 2004. Results of our 2011 survey showed more respondents (6% to 11%) prescribed ASA or VKA according to these guidelines.
CONCLUSION: This survey showed a recognizable pattern of variation for perioperative arterial thrombosis prophylaxis amongst Dutch vascular surgeons, in agreement with reports from other countries over the past 20 years. Although a higher percentage of surgeons complied in 2011 with existing guidelines than in 2004, guidelines were not completely met. Possibly because current guidelines are not fully supported by evidence and do not cover all aspects of perioperative arterial thrombosis prophylaxis. Clearly there is need for (more) convincing data based on RCT’s concerning the various aspects of perioperative arterial thrombosis prophylaxis.