Pharmacotherapy in patients undergoing CABG

2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization (Please do not edit). Pharmacotherapy in patients undergoing CABG

Class I
"1. In patients undergoing CABG, an intraoperative continuous insulin infusion should be initiated to maintain serum glucose level <180 mg/dL to reduce sternal wound infection(Level of Evidence: B-R) "
"2. In patients undergoing CABG, the use of continuous intravenous insulin to achieve and maintain an early postoperative blood glucose concentration of <180 mg/dL while avoiding hypoglycemia is indicated to reduce the incidence of adverse events, including deep sternal wound infection. (Level of Evidence: B-R) "
"3. In patients undergoing CABG, a comprehensive approach to reducing sternal wound infections is recommended(Level of Evidence: B-NR) "

Class IIb
" 4. In patients undergoing CABG, the usefulness of continuous intravenous insulin designed to achieve a target intraoperative blood glucose concentration <140 mg/dL is uncertain (Level of Evidence B-R)".

Class I
"1. In patients undergoing CABG who are already taking daily aspirin preoperatively, it is recommended that they continue taking aspirin until the time of surgery to reduce ischemic events.(Level of Evidence: B-R) "
"2. In patients referred for urgent CABG, clopidogrel and ticagrelor should be discontinued for at least 24 hours before surgery to reduce major bleeding complication(Level of Evidence: B-NR) "
"3. In patients undergoing CABG, discontinuation of short-acting glycoprotein IIb/IIIa inhibitors (eptifibatide and tirofiban) for 4 hours and abciximab for 12 hours before surgery is recommended to reduce the risk of bleeding and transfusion(Level of Evidence: B-NR) "

Class IIa
" 4. In patients undergoing elective CABG who receive P2Y12 receptor inhibitors before surgery, it is reasonable to discontinue clopidogrel for 5 days, ticagrelor for 3 days, and prasugrel for 7 days before CABG to reduce the risk of major bleeding and blood product transfusion. (Level of Evidence B-R)".

Class III (No Benefit)
"5. In patients undergoing elective CABG who are not already taking aspirin, the initiation of aspirin (100–300 mg daily) in the immediate preoperative period (<24 hours before surgery) is not recommended. (Level of Evidence:B-R) "

Class IIa
" 1. In patients undergoing CABG, who do not have a contraindication to beta blockers, the administration of beta blockers before surgery can be beneficial to reduce the incidence of postoperative atrial fibrillation (Level of Evidence B-R)".
'' 2. In patients undergoing CABG, preoperative amiodarone is reasonable to reduce the incidence of postoperative atrial fibrillation. (Level of Evidence B-R)''

Class IIb
" 3. In patients undergoing CABG, who do not have a contraindication to beta blockers, preoperative use of beta blockers may be effective in reducing in-hospital and 30-day mortality rates (Level of Evidence B-NR)".
'' 4. In patients undergoing CABG, the role of preop-erative beta blockers for the prevention of acute postoperative myocardial ischemia, stroke, AKI, or ventricular arrhythmia is uncertain.(Level of Evidence B-NR)''

Class I
"1. In patients undergoing CABG, aspirin (100–325 mg daily) should be initiated within 6 hours postoperatively and then continued indefinitely to reduce the occurrence of SVG closure and adverse cardiovascular events.(Level of Evidence: A) "

Class IIb
" 2. In selected patients undergoing CABG, DAPT with aspirin and ticagrelor or clopidogrel for 1 year may be reasonable to improve vein graft patency compared with aspirin alone(Level of Evidence B-R)".

Class I
"1. In patients after CABG, beta blockers are recommended and should be started as soon as possible to reduce the incidence or clinical sequelae of postoperative atrial fibrillation(Level of Evidence: B-R) "