Drug prescribing and administration in vascular patients: an audit of current practice

Patients undergoing vascular surgery are at high risk of death or cardiac complications. This may be reduced with antiplatelet and statin therapy [1]. Patients at high or intermediate risk of cardiac complications may also benefit from beta (β) blocker therapy [2]. Where β blockers are given, tight heart rate (HR) control is associated with reduced myocardial ischaemia, troponin T release and better long-term outcome [3]. We reviewed drug prescription, administration and HR from day of surgery to day 2 after surgery. A retrospective casenote review of 60 consecutive patients who had undergone non-emergency infra-renal abdominal aortic aneurysm repair (AAA) or femoro-popliteal bypass grafting (fem-pop) in the Royal Infirmary of Edinburgh from Oct 2006 to July 2007. 83% of AAA and 90% of fem-pop patients were prescribed aspirin or clopidogrel; 60% of AAA and 70% fem-pop patients received every dose during the study period. 80% of AAA and 93% of fem-pop patients were prescribed statin therapy; 54% of AAA and 78% fem-pop patients received every dose during study period. 60% of intermediate/high risk [2] AAA patients (n = 27) and 36% of intermediate/high risk fem-pop patients (n = 22) were prescribed β blockers; 61% of AAA and 63% of fem-pop patients received every dose during study period. Some doses appeared to have been withheld appropriately because of excessive bradycardia but in other cases it was not clear why the beta-blocker was not given. On the day of surgery, of the AAA patients who did not receive the prescribed β blocker, 50% had a HR > 75 bpm whereas only 21% of those given their β blocker had a HR > 75 bpm. Antiplatelet drugs and statins were prescribed for a high proportion of these patients. β blocker prescription in intermediate/high risk patients was low in fem-pop patients whose surgery is frequently for critical limb ischaemia. Actual drug administration rates were lower for all drugs. The importance of drug administration around the time of surgery should be highlighted to avoid cardioprotective drugs being inappropriately witheld. Where the oral route is unavailable alternative routes of administration should be used.