VASGBI Trainee Research Development Grants

Golden Jubilee National Hospital, Glasgow

Title
Multi-centre Validation of hEart Rate recoVery as a pErioperative risk measure in Vascular surgical patients: a pilot study (VERVE-V)

Amount
£5,000

Scientific Abstract
As the surgical population ages and the benefits of tailoring perioperative medicine to the individual becomes clearer, the role of perioperative risk assessment becomes increasingly important. Vascular patients often undergo major surgery and due to the nature of their disease have multiple comorbidities adding to their surgical risk. The current gold-standard modality for determining physiological fitness as a predictor of perioperative risk is cardiopulmonary exercise testing (CPET) to maximal effort. A proportion of patients however are not able to perform this test, for example due to arthritis or inability to reach maximal effort, and access to CPET varies regionally due to cost.

Heart rate recovery (HRR) is a marker of vagal tone and has been described as a prognostic marker in heart failure and after non cardiac surgery. Previous studies from our group have confirmed its reproducibility in healthy volunteers performing submaximal exercise. This pilot study aims to validate HRR via submaximal exercise testing in vascular surgical patients against CPET (construct validity), postoperative outcomes (predictive validity) and other risk prediction markers (construct validity).

HRR after submaximal exercise testing may be a simple, robust and cost-effective measure which will guide perioperative risk stratification towards improving patient outcomes in this high-risk population.

University of Oxford Radcliffe Department of Medicine

Title
Platelet function in patients undergoing major, non-cardiac, vascular surgery: a prospective cohort study

Amount
£4,950

Scientific Abstract

Background
Guidelines recommend stopping antiplatelet medications, such as clopidogrel, 5-7 days prior to surgery to reduce the risk of bleeding and facilitate regional anaesthesia. However, these do not take into account individualised responses to antiplatelet therapy. Stopping clopidogrel may not be a viable option for many patients, who are then denied the benefits of regional anaesthesia. There is a need to determine whether regional anaesthesia can safely be performed on patients taking clopidogrel and similar antiplatelet agents.

Aims
To characterise platelet function in patients who are scheduled to undergo elective, major, non-cardiac, vascular surgery.

Methodology
We will conduct a prospective, single-centre, observational cohort study aiming to enrol 80 participants.

Expected outcomes
The primary outcome of this study is to identify the proportion of patients with antiplatelet drug resistance as measured by the thromboelastography (TEG6S) haemostasis analyser.

Implications
The findings of this exploratory study will be used as a platform to eventually develop treatment algorithms to identify patients that may benefit from regional anaesthesia, whilst providing targeted therapeutic interventions to those with impaired platelet activity.