Perioperative Antithrombotic Strategies in Vascular Surgery: A Survey in Germany

Background and Aims: The variety of modern antithrombotic medications complicates the choice of individual perioperative therapy in vascular surgery, especially when more than one antithrombotic option is possible. The aim of this study was to determine the perioperative and periinterventional setting concerning antithrombotics in vascular surgery in Germany. Methods: This article is based on a survey from year 2018 of heads of German vascular surgical departments or units regarding their experience with different anticoagulants. The survey asked for the frequency and time of preoperative pausing of the antithrombotics before various vascular operations or interventions. Results: The evaluable response rate was 52% (169/324). Acetylsalicylic acid was discontinued before open aortic surgery in 9% (15/169) of respondents. Clopidogrel was paused in 65% (107/169) before open aortic surgery, in 25% (41/169) before vascular surgery (like carotid endarterectomy, endovascular aortic repair, or operations on peripheral arteries), and in 11% (18/169) before peripheral percutaneous interventions. Discontinuation of vitamin K antagonists or direct oral anticoagulants (took place before conventional operations in 99.4%; oral anticoagulation was continued for peripheral percutaneous interventions in only 6% (8/169). Management was heterogeneous with regard to the timing of the perioperative medication pause. Clopidogrel was not discontinued according to time specifications in 8%; ticagrelor in 75%; rivaroxaban in 23%; and dabigatran in 29%, compared to the recommendations of the industrial information sheets. Conclusion: The perioperative antithrombotic therapy in German vascular surgery clinics is not uniform and does not correspond to the current specialist recommendations in a notable proportion of clinics.