7
Table 4. Perioperative Therapy (cont'd)
Recommendations COR LOE
Perioperative beta-blocker therapy (cont'd)
In patients with ≥3 RCRI risk factors (e.g., diabetes
mellitus, HF, coronary artery disease, renal insufficiency,
cerebrovascular accident), it may be reasonable to begin
beta blockers before surgery.
IIb B
SR
b
In patients with a compelling long-term indication for beta-
blocker therapy but no other RCRI risk factors, initiating
beta blockers in the perioperative setting as an approach to
reduce perioperative risk is of uncertain benefit.
IIb B
SR
b
In patients in whom beta-blocker therapy is initiated, it
may be reasonable to begin perioperative beta blockers
long enough in advance to assess safety and tolerability,
preferably >1 day before surgery.
IIb B
SR
b
Beta-blocker therapy should NOT be started on the day
of surgery.
III: Harm B
SR
b
Perioperative statin therapy
Statins should be continued in patients currently taking
statins and scheduled for noncardiac surgery.
I B
Perioperative initiation of statin use is reasonable in
patients undergoing vascular surgery.
IIa B
Perioperative initiation of statins may be considered in
patients with clinical indications according to GDMT
who are undergoing elevated-risk procedures.
IIb C
Alpha-2 agonists
Alpha-2 agonists for prevention of cardiac events are
NOT recommended in patients who are undergoing
noncardiac surgery.
III: No
Benefit
B
ACE inhibitors
Continuation of ACE inhibitors or ARBs perioperatively
is reasonable.
IIa B
If ACE inhibitors or ARBs are held before surgery,
it is reasonable to restart as soon as clinically feasible
postoperatively.
IIa C
b
ese recommendations have been designated with SR to emphasize the rigor of support from the
ERC's systematic review.
