Medications to be stopper prior to cardiac surgery

Drugs stopped preop for CTS

- ASA: 3 - 7 days, though some surgeons continue. Decreased perioperative mortality.

- Clopidogrel (Plavix): 5 - 7 days.

- Abciximab (Reopro): 12 - 24 h

- Eptifibatide (Integrilin): 2 - 4 h

- Tirofiban (Aggrastat): 2 - 4 h

- LMWH: 12 h

- UFH: 4 - 8 h or not stopped.

- Warfarin: 4 days

- Thrombolytic Tx (tPA): surgery should be delayed at least 24 h.

- NSAID, Omega-3-fatty acids (fish oils), garlic, vitamin E, gingko, flavanoids: stop ASAP before surgery.

- Smoking: stop at least 4 weeks prior to surgery.

Hold cellcept for 10 days before and 2 weeks after surgery.

Hold Forteo (teriparatide) for 1 week before and 2 weeks after surgery.

Continue with steroids, use stress dose if patient has been on steroids for a long time.

D/c Metformin, switch Pt. to insulin