Preoperative in patients with CAD
Optimal Timing of elective surgery
Balloon angioplasty: Delay noncardiac surgery > 14 days
BMS-PCI: Delay noncardiac surgery >30 days
DES-PCI:
ACS: Delay noncardiac surgery ≥ 12 months
Delay noncardiac surgery ≥ 3 months (time sensitive)
CCS: Delay noncardiac surgery ≥ 12 months
Delay noncardiac surgery ≥ 3 months (time sensitive)
Minimum Time From Drug Interruption to Restoration of Platelet Function
Aspirin: 4 days
Clopidogrel: 5-7 days
Presugrel: 7-10 days
Tigagrelor: 3-5
Perioperative betablocker
Beta blockers should be continued during the perioperative period as appropriate based on clinical circumstances.
Perioperative RAASi
HFrEF: In patients who are on chronic RAAS inhibitors, it is reasonable to continue their medication during the perioperative period.
Hypertension, CV risk: For select patients with hypertension on chronic renin-angiotensin-aldosterone system inhibitors (RAASi) undergoing elevated-risk non-cardiac surgery (NCS), it may be beneficial to omit these medications 24 hours before surgery to limit the risk of intraoperative hypotension.
Perioperative SGLT2-i
In patients scheduled for noncardiac surgery, SGLT2 inhibitors should be discontinued 3 to 4 days before surgery to reduce the risk of perioperative metabolic acidosis.