Why the study?
Considerable differences exist in clinical practice guideline recommendations for the perioperative management of stented patients needing elective noncardiac surgery.
What is the quality and consistency of clinical practice guidelines for perioperative management of DAPT in stented patients undergoing noncardiac surgery?
Systematic Review (n=10)
What is the quality and consistency of clinical practice guidelines for perioperative management of DAPT in stented patients undergoing noncardiac surgery?
The ACCP, ESC/ESA, and ACC/AHA guidelines are the highest quality for perioperative DAPT management in stented patients undergoing noncardiac surgery, though recommendations remain inconsistent across guidelines.
Guideline inconsistency warrants cautious perioperative DAPT decisions; challenges CPG reliability and leaves open need for harmonized recommendations.
WHAT IS KNOWN AND OBJECTIVE: Despite the availability of clinical practice guidelines (CPGs), there are considerable differences in their recommendations in the perioperative management of stented patients who need elective noncardiac surgery. Our aim was to systematically review the quality of CPGs for perioperative management of dual antiplatelet therapy (DAPT) and summarize the recommendations. METHODS: A systematic search for perioperative DAPT guidelines was conducted on PubMed, Embase and websites of guideline organizations and professional societies until 4 February 2021. Independently, two assessors appraised the quality of CPGs using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument and extracted the data. Recommendations were summarized, and a comparative study was conducted to analyse the consistency among guidelines. RESULTS AND DISCUSSION: A total of 10 guidelines fulfilled our inclusion criteria. The domain of scope and purpose and clarity of presentation obtained the highest median scores, while the domain of stakeholder involvement and rigour of development obtained the lowest median scores. Three guidelines (ACCP, ESC/ESA and ACC/AHA) with a score of at least 60% in most AGREE II domains were recommended. Recommendations across perioperative management of DAPT guidelines were inconsistent. WHAT IS NEW AND CONCLUSION: The ACCP, ESC/ESA and ACC/AHA CPGs were recommended. There is a need for high-quality prospective studies assessing different management strategies on this issue. Given the lack of consensus, the results of this study will help to guide perioperative dual antiplatelet management strategies for patients with coronary stents who are undergoing noncardiac surgery.
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Wang et al. (2021) conducted a systematic review in perioperative management of dual antiplatelet therapy in patients with noncardiac surgery (n=10). Clinical practice guidelines was evaluated on Quality of CPGs using the AGREE II instrument. Clinical practice guidelines for perioperative DAPT management in noncardiac surgery showed inconsistent recommendations, with only 3 of 10 guidelines scoring at least 60% in most AGREE II domains.
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