[Cardiovascular management of patients undergoing noncardiac surgery]

Area of Science:

• Cardiology
• Perioperative Medicine
• Risk Assessment

Background:

• Cardiovascular diseases are common in patients undergoing noncardiac surgery (NCS).
• Accurate preoperative risk assessment is crucial for patient management and outcomes.
• Multidisciplinary involvement is often necessary for comprehensive care.

Purpose of the Study:

• To outline the risk assessment strategy for patients with cardiovascular diseases undergoing NCS.
• To provide guidance on managing perioperative cardiovascular drug treatment.
• To clarify recommendations regarding oral anticoagulation management.

Main Methods:

• Evaluation of patient's disease profile, age, and exercise tolerance.
• Utilizing cardiac biomarkers such as N-terminal pro-brain natriuretic peptide (NT-proBNP) and troponin.
• Review of current guidelines for perioperative cardiovascular medication and anticoagulation management.

Main Results:

• Risk stratification depends on the surgical procedure and patient's underlying cardiovascular condition and age.
• Subjective symptoms like exercise tolerance and objective biomarker levels guide the need for further investigations.
• Perioperative continuation of existing cardiovascular medications is generally recommended, while initiating new treatments solely for surgery is discouraged.
• General heparin bridging for oral anticoagulation is no longer advised, with specific pausing guidelines available.

Conclusions:

• A tailored approach to cardiovascular risk assessment is essential for patients undergoing NCS.
• Optimizing perioperative medication management and anticoagulation strategies improves patient safety.
• Adherence to updated guidelines ensures evidence-based care in perioperative cardiology.