Medication Management Flashcards
What did they POISE I trial demonstrate?
In patients started on metoprolol XR 2-4 hours pre-op, at 30 days there was an increased reins of death and stroke, though less MI, in the patients in the beta-blocker arm.
What are the exceptions to initiation of beta-blocker in the pre-operative period?
Beta-blocker is clearly indicated for a cardiac condition (ie. angina or arrhythmia)
What did the POISE II trial show?
Equal rates of death or MI compared to placebo, but more major bleeding in the ASA group
When do you hold ASA prior to non-cardiac surgery?
At least 3 days before non-cardiac surgery to reduce the risk of major bleeding.
When would you continue ASA in the peri-operative period?
With recent BMS (< 6 weeks) OR recent DES (<3-12 months).
Continue ASA w/hx of stent even > 1 year where ever possible, unless the procedure is very high risk of bleeding
How long should you delay elective surgery in patients post-PCI?
- Delay surgery 14 days after balloon angioplasty w/o stent
- Delay at least 1 month after BMS
- Delay at least 3 months after DES
- If semi-urgent - delay at least 1-month post-PCI*
How long do you hold clopidogrel and ticagrelor prior to elective surgery?
5-7 days
How long do you hold prasugrel for prior to elective surgery?
7-10 days
How do you manage DAPT therapy within the first 4-6 weeks post BMS/DES?
Continue DAPT unless risk of bleeding outweighs the risk of stent thrombosis.
What are the peri-operative recommendations for ACEi management?
Hold ACEi/ARB starting 24 hours before non-cardiac surgery and restart Day 2 after surgery if the patient is hemodynamically stable, with baseline creatinine and eating/drinking well (euvolemic)
What are the perioperative recommendations for biologic medications?
Biologic medications should be withheld close to 1 dosing cycle as scheduling permits prior to elective THA/TKA and restarted after evidence of wound healing (typically 14d before and 14d after)
