Ensure peri-op CABG medication regimens are optimized

As a hospital pharmacist, you'll see more focus on medication choices after coronary artery bypass graft (CABG) surgery to improve care and reduce hospital readmissions. Follow the new American Heart Association (AHA) recommendations to ensure peri-operative CABG medication regimens are optimized and help prevent readmissions...

Aspirin

Give 81 to 325 mg/day before and after CABG. Try to restart within 6 hours after surgery, if safe. Use the lower dose for those at higher risk of bleeding. For patients started on a higher dose, switch to 81 mg within about one year post-CABG and continue it indefinitely.

Beta-blockers

Start a beta-blocker at least several days before CABG to reduce atrial fibrillation risk. Titrate to a resting pulse of about 60, if tolerated. Keep in mind that surgeons will need to document giving a beta-blocker within 24 hours of incision, as part of their PQRS quality measures. Continue the beta-blocker for at least one month. But use it for about 3 years post-MI and indefinitely for systolic heart failure.

Statins

Use a high-intensity statin (atorvastatin 80 mg, etc) for most CABG patients and moderate-intensity (atorvastatin 20 mg, etc) if side effects or drug interactions are a concern.

Use appropriate resources for discharge planning. Stress the importance of cardiac rehabilitation. This helps prevent MIs and readmissions, reduce mortality and improve medication adherence. Call patients within 2 days of discharge to make sure they are taking their medications and following the discharge plan.

References

• Kulik A, Ruel M, Jneid H, Ferguson TB, Hiratzka LF, Ikonomidis JS, Lopez-Jimenez F, McNallan SM, Patel M, Roger VL, Sellke FW, Sica DA, Zimmerman L; American Heart Association Council on Cardiovascular Surgery and Anesthesia. Secondary prevention after coronary artery bypass graft surgery: a scientific statement from the American Heart Association. Circulation. 2015 Mar 10;131(10):927-64. Available at: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000182?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

  Khanderia U, Townsend KA, Erickson SR, Vlasnik J, Prager RL, Eagle KA. Medication adherence following coronary artery bypass graft surgery: assessment of beliefs and attitudes. Ann Pharmacother. 2008 Feb;42(2):192-9. Available at: https://journals.sagepub.com/doi/10.1345/aph.1K497?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed&