Perioperative: Medical management
Result
-
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 days
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.
References
Thompson A, Fleischmann KE, Smilowitz NR, Aggarwal NR, Ahmad FS, Allen RB, Altin SE, Auerbach A, Berger JS, Chow B, Dakik HA, de las Fuentes L, Eisenstein EL, Gerhard-Herman M, Ghadimi K, Kachulis B, Leclerc J, Lee CS, Macaulay TE, Mates G, Merli GJ, Mukherjee D; Parwani P, Poole JE, Rich MW, Ruetzler K, Stain SC, Sweitzer B, Talbot AW, Vallabhajosyula S, Whittle J, Williams KA Sr. 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM guideline for perioperative cardiovascular management for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024;150:e351–e442.