A multidisciplinary intervention to improve postoperative antithrombotic therapy after urgent coronary artery bypass-grafts.

Abstract

Objectives: The objective of this study was to assess whether implementing a protocol could improve adherence to European guidelines on postoperative antithrombotic therapy prescription in patients undergoing coronary artery bypass-grafts surgery (CABG) after acute coronary syndrome (ACS).

Methods: We included patients who underwent cardiac surgery between January 2018 and December 2022. The population was divided in two groups, one before (group 1) and one after (group 2) the dissemination of a protocol on postoperative antithrombotic therapy issued by a multidisciplinary collaboration (January 2021) and its subsequent implementation during ward rounds. We analysed the protocol's impact on adherence to European guidelines in terms of antithrombotic therapy at discharge.

Results: We included 259 patients, 83.8% were men and the median age was 67 [58; 74] years. At baseline, group 1 (n=152) and group 2 (n=107) had similar demographic characteristics except for smoking status and ACS events. Patients in group 2 had a higher rate of guideline adherence in terms of postoperative antithrombotic therapy (group 1=58.6% vs. group 2=82.2%, P<0.001). Using logistic regression accounting for demographic and temporal factors, the effect of the intervention was positive but not statistically significant. Adherence increased significantly over time, suggesting that the intervention contributed to an overall trend of improved adherence as apart of ongoing quality improvement efforts.

Conclusion: Implementing the protocol was associated with a positive effect on guideline adherence for postoperative antithrombotic therapy in ACS patients undergoing CABG. Although the intervention's independent effect was not statistically significant after adjustment, the findings support its role in achieving sustained improvement in adherence over time.