Perioperative medication management

  • No initiation or continuation of ASA for prevention of periop cardiac events

    • D/C chronic ASA ≥3 days preop to ↓ bleeding risk

      • Restart when risk of surgical bleeding has passed (ex 8-10 days after major noncardiac sx)

    • Exceptions:

      • Recent coronary artery stent

      • CEA

      • +/- certain surgical interventions (ex free flap, acute limb ischemia)

 

  • No α2 agonist or β-blocker initiation w/in 24 hrs of surgery

    • Continue chronic β-blockers perioperatively

      • If preop hTN, consider ↓ing or holding preop β-blocker dose

 

  • Withhold ACEI and ARBs 24 hrs preop

    • Consider restarting POD2 if hemodynamically stable

 

  • Continue chronic statin tx periop

 

  • Facilitate smoking cessation preop (Ideally ≥4 wks preop)

    • Smoking cessation counselling, nicotine replacement therapy

 

Adapted from Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery. Canadian Journal of Cardiology. January 2017, Volume 33, Issue 1, Pages 17–32