A prospective observational study on peri-operative management strategies and outcomes in patients on anti-platelet therapy in elective major non cardiac surgery

Coronary artery disease is the most common heart disease in Indian population. On an average every 1 in 20 adults of age 20 and above suffer from coronary artery disease at various levels of progression. About a quarter (24.8%) of deaths in India in 2010 were attributable to cardiovascular diseases. About 60,000 patients on an average in a year undergo CABG surgery in India. (1) About 5.5 lakh stents are being utilized annually in India on an average. (2)

Patients undergo one of the three paths in the management of coronary heart disease/high risk paitents based on complex scoring systems. Firstly, in patients who have significant comorbidities and have stable angina are medically managed with anti-platelet therapy, anti-anginal drugs, risk factor control and lifestyle modifications. Patients who have unstable angina, NSTEMI usually undergo a risk stratification using SYNTAX scoring and multi-disciplinary discussion among the cardiac team in hospitals and either undergo a CABG procedure or a PCI. Patients who have an Acute Coronary Syndrome come in an emergency situation and undergo PCI procedure.

Having said that, the anaesthetic implications of such patients in an elective non-cardiac surgery are huge and need to be dealt with great consideration. The risk-benefit consideration starts from the surgery OPD, then in PAC clinic and then one day prior to taking the patient on OT table.

We are conducting this study to know the number of patients on anti-platelet therapy, indication for starting them and other procedures they may have undergone. We will be also be recording the peri-operative outcomes of these patients using RCRI scores and post operative MACE.