Perioperative Management of Medications for CABG

Medications Requiring Discontinuation Before CABG

• The American Heart Association recommends discontinuing clopidogrel and ticagrelor at least 5 days before elective CABG 1, 2, 3
• The American Heart Association recommends discontinuing prasugrel at least 7 days before elective CABG 2, 3
• The American Heart Association recommends continuing aspirin perioperatively (100-325 mg daily) 1
• The American College of Cardiology recommends discontinuing enoxaparin 12-24 hours before CABG and transitioning to unfractionated heparin 2, 3
• The American College of Cardiology recommends discontinuing fondaparinux 24 hours before CABG and transitioning to unfractionated heparin 2, 3
• The American College of Cardiology recommends discontinuing bivalirudin 3 hours before CABG and transitioning to unfractionated heparin 2, 3
• The American Heart Association recommends continuing unfractionated heparin until surgery 2, 3
• The American College of Cardiology recommends discontinuing eptifibatide or tirofiban 2-4 hours before surgery 1, 2, 3
• The American College of Cardiology recommends discontinuing abciximab at least 12 hours before surgery 1

Critical Considerations

• The American Heart Association advises against confusing duloxetine with antiplatelet or anticoagulant medications that require specific preoperative discontinuation timing 1, 2, 3