ABC | Volume 111, Nº4, Octuber 2018

Original Article Borges et al Inadequate management of antiplatelet agents Arq Bras Cardiol. 2018; 111(4):596-604 1. Weiser TG, Haynes AB, Molina G, Lipsitz SR, Esquivel MM, Uribe-Leitz T, et al. Size and distribution of the global volume of surgery in 2012. Bull World Health Organ. 2016;94(3):201-9F. 2. Yu PC, Calderaro D, Gualandro DM, Marques AC, Pastana AF, Prandini JC, et al. Non-cardiac surgery in developing countries: epidemiological aspects and economical opportunities--the case of Brazil. PLoS One. 2010;5(5):e10607. 3. Weiser TG, Regenbogen SE, Thompson KD, Haynes AB, Lipsitz SR, Berry WR, et al. An estimation of the global volume of surgery: amodelling strategy based on available data. Lancet. 2008;372(9633):139-44. 4. Botto F, Alonso-Coello P, Chan MT, Villar JC, Xavier D, Srinathan S, et al. Myocardial injury after noncardiac surgery: a large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes. Anesthesiology. 2014;120(3):564-78. 5. Kristensen SD, Knuuti J, Saraste A, Anker S, Batker HE, DeHert S, et al. [2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment andmanagement]. Kardiol Pol. 2014;72(11):857-918. 6. Devereaux PJ, Chan MT, Alonso-Coello P, Walsh M, Berwanger O, Villar JC, et al; Vascular Events In Noncardiac Surgery Patients Cohort Evaluation (VISION) Study Investigators. Association between postoperative troponin levels and 30-daymortality among patients undergoing noncardiac surgery. JAMA. 2012;307(21):2295-304. Erratum in: JAMA. 2012;307(24):2590. 7. Devereaux PJ, Xavier D, Pogue J, Guyatt G, Sigamani A, Garutti I, et al; POISE (PeriOperative ISchemic Evaluation) Investigators. Characteristics and short- termprognosis of perioperativemyocardial infarction in patients undergoing noncardiac surgery: a cohort study. Ann Intern Med. 2011;154(8):523-8. 8. Puelacher C, Lurati Buse G, Seeberger D, Sazgary L, Marbot S, Lampart A, et al; BASEL-PMI Investigators. Perioperative myocardial injury after noncardiac surgery: incidence, mortality, and characterization.Circulation. 2018;137(12):1221-32. 9. Silva MV, Dusse LM, Vieira LM, Carvalho Md. Platelet antiaggregants in primary and secondary prevention of atherothrombotic events. Arq Bras Cardiol. 2013;100(6):e78-84. 10. Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK, et al; Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001;345(7):494-502. Erratum in: N Engl J Med. 2001;345(20):1506; N Engl J Med. 2001;345(23):1716. 11. Columbo JA, Lambour AJ, Sundling RA, Chauhan NB, Bessen SY, Linshaw DL, et al. A meta-analysis of the impact of aspirin, clopidogrel, and dual antiplatelet therapy on bleeding complications in noncardiac surgery. Ann Surg. 2018;267(1):1-10. 12. Eikelboom JW, Hirsh J, Spencer FA, Baglin TP, Weitz JI. Antiplatelet drugs: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e89S-e119S. 13. Baigent C, Blackwell L, Collins R, Emberson J, Godwin J, Peto R, et al; Antithrombotic Trialists’ (ATT) Collaboration. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta- analysis of individual participant data from randomised trials. Lancet. 2009;373(9678):1849-60. 14. Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, et al; American College of Cardiology; American Heart Association. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J AmColl Cardiol. 2014;64(22):e77-137. 15. Lorga Filho AM, Azmus AD, Soeiro AM, Quadros AS, Avezum Junior A, Marques AC, et al. [Brazilian guidelines on platelet antiaggregants and anticoagulants in cardiology]. Arq Bras Cardiol. 2013;101(3 Suppl 3):1-93. References Divergences in conducts seem to stress the need of defining internal protocols, to divulge guidelines and continued education to ensure patients’ safety. Additionally, it was concluded that patients with more schooling, or a previous history of AMI, agree more with the cardiology guidelines, i.e., patients who have less schooling should be better accompanied in the management of the medicine therapy, and also to have more access to information about their health condition. However, fear of the possibility of a new infarction in a patient leads physicians no to hesitate to suspend the antiplatelet agent in non-cardiac surgical procedures when they are not neurosurgeries or transurethral resection of the prostate. Author contributions Conception and design of the research: Borges JMDM, AlmeidaPA, Nascimento MMG, Barreto Filho JAS, Rosa MB, Sousa ACS; Acquisition of data: Borges JMDM, Almeida PA; Analysis and interpretation of the data: Borges JMDM, Nascimento MMG, Barreto Filho JAS, Rosa MB, Sousa ACS; Statistical analysis: Borges JMDM,NascimentoMMG, BarretoFilho JAS, Sousa ACS; Obtaining financing: Borges JMDM, Sousa ACS; Writing of the manuscript: Borges JMDM, Nascimento MMG, Rosa MB, Sousa ACS; Critical revision of the manuscript for intellectual content: Borges JMDM, Nascimento MMG, Barreto Filho JAS, Rosa MB, Sousa ACS. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding This study was funded by FAPITEC. Study Association This article is part of the thesis of Doctoral submitted by Juliana Maria Dantas Mendonça, from Núcleo de Pós-graduação em Ciências da Saúde da Universidade Federal de Sergipe. Ethics approval and consent to participate This study was approved by the Ethics Committee of the Universidade Federal de Sergipe under the protocol number 33899914.2.0000.5546. All the procedures in this study were in accordance with the 1975 Helsinki Declaration, updated in 2013. Informed consent was obtained from all participants included in the study. 602