ABC | Volume 111, Nº4, Octuber 2018

Original Article Factors Associated with Inadequate Management of Antiplatelet Agents in Perioperative Period of Non-Cardiac Surgeries Juliana Maria Dantas Mendonça Borges, 1,2 Pamella de Assis Almeida, 1 Mariana Martins Gonzaga do Nascimento, 3 José Augusto Soares Barreto Filho, 1,4,5 Mario Borges Rosa, 3 Antonio Carlos Sobral Sousa 1,4,5 Universidade Federal de Sergipe, 1 Aracaju, SE – Brazil Universidade Tiradentes, 2 Aracaju, SE - Brazil Instituto Para Práticas Seguras no Uso de Medicamentos, 3 Belo Horizonte, MG – Brazil Centro de Ensino e Pesquisa da Fundação São Lucas, 4 Aracaju, SE – Brazil Departamento de Medicina da Universidade Federal de Sergipe (UFS), 5 Aracaju, SE - Brazil Mailing Address: Juliana Maria Dantas Mendonça • Rua Poeta Vinicius de Moraes, 60, apt 704. Postal Code 49037-490, Aracaju, SE – Brazil E-mail: jumariapharma@gmail.com , judantas20@hotmail.com Manuscript received February 01, 2018, revised manuscript May 11, 2018, accepted May 23, 2018 DOI: 10.5935/abc.20180162 Abstract Background: The current guidelines dispose recommendations to manage antiplatelet agents in the perioperative period; however, the daily medical practices lack standardization. Objectives: To asses factors associated with inadequate management of antiplatelet agents in the perioperative period of non-cardiac surgeries. Methods: Cross-sectional Study conducted in hospital from October 2014 to October 2016. The study dependent variable was a therapy that did not comply with the recommendations in the Brazilian Association of Cardiology (SBC) guidelines. The independent variables included some characteristics, the people in charge of the management and causes of lack of adherence to those guidelines. Variables were included in the multivariate model. Analysis was based on the odds ratio (OR) value and its respective 95% confidence interval (CI) estimated by means of logistic regression with 5% significance level. Results: The sample was composed of adult patients submitted to non-cardiac surgeries and who would use acetylsalicylic acid (aspirin) or clopidogrel (n = 161). The management failed to comply with the recommendations in the guidelines in 80.75% of the sample. Surgeons had the highest number of noncomplying orientations (n = 63). After multivariate analysis it was observed that patients with a higher level of schooling (OR = 0.24; CI95% 0.07-0.78) and those with a previous episode of acute myocardial infarction (AMI) (OR = 0.18; CI95% 0.04-0.95) had a higher probability of using a therapy complying with the guidelines. Conclusion: Positive association between patients’ schooling level, or thosewith a history of previous AMI, withmanagement of the use of aspirin and clopidogrel in the perioperative period of non-cardiac surgeries. However, diverging conducts stress the need of having internal protocol defined. (Arq Bras Cardiol. 2018; 111(4):596-604) Keywords: Surgery/perioperative care; Intraoperative Care; Platelet Aggregation; Adults; Myocardial Infarction; Educational Status. Introduction A study published in 20018 by the World Health Organization (WHO) informed that in 2012 313 million surgeries had been performed worldwide, thus evidencing a 38% increase in eight years. During that period in Brazil approximately 6 thousand surgeries per 100.000 inhabitants were performed, summing up about 10 to 13 million surgical procedures in 2012, 1 and the rate of non-cardiac surgeries was estimated at 3 million per year. 2 These figures still are bound to increase due to several factors, such as the growing and ageing population. 3 In 2014, Botto et al., 4 stated that cardiac complications are the main cause of post-operation deaths of patients submitted to non-cardiac surgeries. These are alarming data once in the world over 10 million adults every year have at least one cardiac complication in the first 30 days following a non‑cardiac surgical procedure. 4,5 Among the cardiac complications arising from these types of procedure the most common is acute myocardial infarction (AMI), 4,6,7 which is also associated with long-term mortality, although often enough it is detected earlier during clinical screening. 8 Due to the key role performed by platelets in pathogenesis of atherothrombotic events, using antiplatelet agents is of the essence for primary and secondary prevention of cardiovascular events. 9 However, although the use of antiplatelet agents has increased cardiovascular safety of many 596