Magazine article Drug Topics

New Guide Targets Heart Patients Undergoing Noncardiac Surgery

Magazine article Drug Topics

New Guide Targets Heart Patients Undergoing Noncardiac Surgery

Article excerpt

Statin therapy should be continued throughout noncardiac surgery. So says a new update from bodi the American College of Cardiology and American Heart Association (ACC/AHA). The ACQ AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery has been issued as a revision to the 2002 guidelines.

Although it was previously unclear what to do about cholesterol-lowering statins in patients with heart disease who were about to undergo noncardiac surgery, new clinical trial evidence shows a protective effect of perioperative statin use on cardiac complications during surgery. Therefore, statins should not be discontinued before surgery, according to the new guide.

"The cardiovascular benefits of statins are well known and decrease both cardiovascular morbidity and mortality in patients who have heart disease and those with risk factors for heart disease," said Michael A, Militello, Pharm.D., a cardiology clinical specialist at the Cleveland Clinic. Discontinuation prior to surgery could lead to increased incidence of cardiovascular events, he said. Also, it is now reasonable to use statins in patients undergoing vascular surgery and in patients with at least one cardiovascular risk factor undergoing an intermediate-risk procedure such as orthopedic, prostate, or head and neck surgery, he explained.

The updated guidelines also advocate stopping antiplatelet therapy for as short a time as possible after stent placement. This is a significant change from the previous guidelines that called for discontinuation of antiplatelet meds before surgery to reduce the risks for excessive bleeding associated with any surgical procedure.

The antiplatelet therapy duration varies for patients who have undergone percutaneous coronary intervention (PCI) and who need elective noncardiac surgery, according to Militello, and depends on the modality of PCI performed. Specifically, for patients who have had PCI with placement of a bare metal stent (BMS), dual anitplatelet therapy should be continued for four to six weeks after PCI and noncardiac surgery delayed until that time. "The thienopyridine should be discontinued one week prior to any noncardiac surgery to allow for adequate washout of antiplatelet effect," he explained. However, "if a noncardiac surgery needs to be performed prior to four weeks after BMS placement, then the dual therapy should be continued since the risk of stent thrombosis is significant," he added. …

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