Preop Flashcards
RCRI factors (5)
Cutoff for elevated risk
CAD CHF Cr > 2 CVA/TIA IDDM
2+ factors
High risk surgeries
Vascular Thoracic Transplant Duodeno-pancreatic Liver resection or bile duct Esophagectomy Perforated bowel repair Adrenal resection Total cystectomy Pneumonectomy
Reasonable to stress test if
Class IIa
Patient at elevated risk and has poor functional capacity
Also if high risk surgery
Who needs revascularization
Class I - those who would otherwise have the indication
BUT don’t do it if the surgery is emergent
Beta blockers before surgery
Generally do not start them, but CAN in very high risk patients
Statins before surgery
Class IIa
Reasonable to start before a vascular surgery
When to do elective surgery after:
BMS
DES
30 days - class I 6 months - class I, 3-6 mo - Class IIb
When not okay to stop P2Y12 if:
BMS
DES
Class III
< 30 days
<3 months
When to bridge Coumadin
Recent CVA or CHADS2VASC >= 7
Assess bleeding risk if Chads2 5-6
When to restart AC after surgery or procedure
Coumadin - evening of procedure
DOAC - 24-72 hours after
