Cardiology>>>>>Assessment for Surgery
Question 2#

You are asked to review a patient on a surgical ward who has been admitted for colonic surgery the next day to remove a tumour. You discover that she has a history of ischaemic heart disease and underwent elective PCI to the LAD 18 months previously. She is currently taking aspirin, ramipril, and simvastatin. She has a resting heart rate of 80 bpm in sinus rhythm. Her blood pressure is 105/80 mmHg. She is euvolaemic. The surgeon wishes to stop the aspirin prior to the surgery.

Which one of the following medication changes do you recommend?

a. Stop aspirin, as the risks of postoperative bleeding outweigh the cardiac risks
b. Start a beta-blocker in order to minimize her cardiac risks
c. Stop the simvastatin, as statins are associated with an increased risk of cancer
d. Continue aspirin despite the risks of bleeding
e. Give a long-acting nitrate to help with perioperative ischaemia

Correct Answer is D

Comment:

An antiplatelet agent should be continued, especially where coronary intervention has taken place. The risks of bleeding do not outweigh the risks of a coronary event in this circumstance.

Beta-blockers are helpful in reducing risk in the perioperative period but should be uptitrated slowly to avoid hypotension.

Statins are not proven to be associated with cancer. Abrupt withdrawal in the perioperative period might be harmful. There is no evidence to support nitrates in this circumstance.