Peri-operative Medication Management - β-Blockade and ...
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Peri-operative Medication Management - β-Blockade and Other Cardiac Drugs:

Evaluate for peri-operative β-blockade

 • Continue β-blocker: if already taking for other indication (e.g. CAD, arrhythmia, HTN) for goal HR 55-65 (Class I, LOE C)

 • Initiate β-blocker: ≥3 RCRI risk factors or if pt has indication for βB otherwise (Class IIa, LOE B). Never start on day of surgery!

 • Uncertain role of β-blocker: if no known CAD but either +stress test or high risk factors

Anti-platelet management:

 • 1° prevention – can generally be held prior to surgery

 • 2° prevention – continue ASA 81mg unless high risk of bleeding (intramedullary spine, intracranial, hip, knee, possibly prostate)

 • DAPT post PCI: POBA <14d, BMS <30d, DES <6-12mo→ delay elective surgery. If urgent, continue ASA, hold P2Y12i x5d.

ACEi/ARB: Pts have more transient peri- and post-op episodes of HoTN; no diff in death, post-op MI, stroke; ↑ or ↓ AKI unclear

 • Discontinue ACEi/ARB night before surgery (unless used for HF and BP ok), failure to restart ARB within 48h ↑ 30-d mortality

Other: All other anti-hypertensives should be continued perioperatively to goal BP <180/100 to avoid bleeding.

Anticoagulation: Recommendations for bridging in patients using VKAs stratified by risk



#Perioperative #medications #management #preoperative
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Account created for the MGH Internal Medicine Housestaff Manual "White Book" - https://stk10.github.io/MGH-Docs/WhiteBook-2019-2020.pdf
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