SPAQI consensus on preoperative management of cardiovascular medications
USA: The Society for Perioperative Assessment and Quality Improvement (SPAQI) has released a consensus statement on the preoperative management of cardiovascular medications.
The aim of the consensus effort, published in Mayo Clinic Proceedings, is to provide perioperative clinicians with guidance on the management of cardiovascular medications that are encountered commonly during the preoperative evaluation. A modified Delphi process to establish consensus.
The authors provided recommendations for the management of the following twenty-one classes of medications preoperatively: angiotensin-converting enzyme inhibitors, α-adrenergic receptor antagonists, angiotensin receptor–neprilysin inhibitors, angiotensin II receptor blockers, calcium-channel blockers, β-adrenoceptor blockers, direct-acting vasodilators, centrally acting sympatholytic medications, thiazide diuretics, loop diuretics, endothelin receptor antagonists, potassium-sparing diuretics, nitrodilators, cardiac glycosides, class III antiarrhythmic agents, phosphodiesterase-5 inhibitors, renin inhibitors, potassium-channel openers, sodium-channel blockers, class I antiarrhythmic agents, and sodium glucose cotransportor-2 inhibitors.
- Consensus recommendation for α-blockers: Consensus was achieved that α-blockers should be CONTINUED on the morning of surgery.
- Consensus recommendation for ACEIs and ARBs: Consensus was achieved that ACEIs and ARBs generally should be HELD on the morning of surgery.
- Consensus recommendation for ARNIs: Consensus was achieved that ARNIs should be HELD on the morning of surgery.
- Consensus recommendation for β-blockers: Consensus was achieved that β-blockers should be CONTINUED on the morning of surgery.
- Consensus recommendation for CCBs: Consensus was achieved that CCBs should be CONTINUED on the morning of surgery.
- Consensus recommendation for centrally acting sympatholytic medications: Consensus was achieved that centrally acting sympatholytic medications should be CONTINUED on the morning of surgery.
- Consensus recommendation for direct-acting vasodilators: Consensus was achieved that direct-acting vasodilators should be CONTINUED on the morning of surgery.
- Consensus recommendation for potassium-channel openers: Consensus was achieved that potassium-channel openers should be CONTINUED on the morning of surgery.·
- Consensus recommendations for loop diuretics: Consensus was achieved that loop diuretics should be HELD on the morning of surgery.
- Consensus recommendations for thiazide and potassium-sparing diuretics: Consensus was achieved that thiazide and potassium-sparing diuretics should be CONTINUED on the morning of surgery.
- Consensus recommendation for endothelin receptor antagonists: Consensus was achieved that endothelin receptor antagonists should be CONTINUED on the morning of surgery.
- Consensus recommendation for cardiac glycosides: Consensus was achieved that cardiac glycosides should be CONTINUED on the morning of surgery.
- Consensus recommendation for nitrodilators: Consensus was achieved that nitrodilators should be CONTINUED on the morning of surgery.
- Consensus recommendation for PDE5 inhibitors: Consensus was achieved that PDE5 inhibitors should be CONTINUED on the morning of surgery if prescribed for PAH. The consensus was achieved to HOLD PDE5 inhibitors used for erectile dysfunction at least 24 hours before surgery.
- Consensus recommendation for class III antiarrhythmic agents: Consensus was achieved that class III antiarrhythmic agents should be CONTINUED on the morning of surgery.
- Consensus recommendation for renin inhibitors: Consensus was achieved that renin inhibitors should be HELD on the morning of surgery.
- Consensus recommendation for class I antiarrhythmic agents: Consensus was achieved that class I antiarrhythmic agents should be CONTINUED on the morning of surgery.
- Consensus recommendation for sodium-channel blockers: Consensus was achieved that sodium-channel blockers should be CONTINUED on the morning of surgery.
- Consensus recommendation for SGLT2 inhibitors: Consensus was achieved that SGLT2 inhibitors should be HELD IN ADVANCE before surgery. Specifically, discontinue dapagliflozin, empagliflozin, and canagliflozin for 3 days before the procedure, irrespective of a diagnosis of diabetes. Discontinue ertugliflozin for 4 days before the procedure, irrespective of a diagnosis of diabetes.
The researchers conclude, "This consensus statement reflects the best available data at the time the manuscript was prepared. The results of future studies may require revisions to the recommendations."
Reference:
"Preoperative Management of Cardiovascular Medications: A Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement" was published in Mayo Clinic Proceedings.
DOI: https://doi.org/10.1016/j.mayocp.2022.03.039
