CABG Considerations

Before CABG overall management strategy

• Continue aspirin

• Hold P2Y12 inhibitor for a designated time (depends on circumstance)

For pre-CABG management therapy: what should be done with aspirin?

Continued

For pre-CABG management therapy, urgent CABG; how long should the oral P2Y12 inhibitors (clopidogrel, prasugrel, ticagrelor) be held?

>24 hours

For pre-CABG management therapy, elective CABG; how long should the oral P2Y12 inhibitors (clopidogrel, prasugrel, ticagrelor) be held?

• Clopidogrel: 5 days prior

• Prasugrel: 7 days prior

• Ticagrelor: 3-5 days prior

For pre-CABG management: medications to add?

• Beta blocker

• Amiodarone (to reduce post-operation afib)

For intraoperative CABG management, what should be done with UFH?

Continued as continuous IV infusion to target ACT

For intraoperative CABG management: medications to add?

Insulin, continuous IV

• Target BG <180 mg/dL

Post-CABG overall management strategy

• DAPT with aspirin + clopidogrel or ticagrelor, x 12 months

• Then continue aspirin indefinitely

For post-CABG management therapy: what should be done with aspirin?

Continued at 81mg PO daily, indefinitely

For post-CABG management: medications to add?

• Beta-blocker — start ASAP to reduce postoperative afib

• IV insulin infusion — target BG <180 mg/d: