Priority 20 from the Heart Surgery PSP
|UNCERTAINTY: What are the best cardiovascular medications for management in heart surgery (e.g. ACE-inhibitors, antiplatelet, anticoagulant)? (JLA PSP Priority 20)|
|JLA question ID||0088/20|
|Explanatory note||Numerous references were identified by our search strategy in terms of the best cardiovascular medicines to use in perioperative management for cardiac surgery, both in recent guidelines and systematic reviews.
However, considering the broad and controversial nature of the question, further research may be required.
~ What anti-platelet agents should be used routinely after CABG surgery? Effect of NOACs vs warfarin for post operative AF?
Sousa-Uva M, Head SJ, Milojevic M, Collet JP, Landoni G, Castella M, et al. 2017 EACTS Guidelines on perioperative medication in adult cardiac surgery. Eur J Cardiothorac Surg. 2018;53(1):5-33; Andras A, Stansby G, Hansrani M. Homocysteine lowering interventions for peripheral arterial disease and bypass grafts. Cochrane Database of Systematic Reviews. 2013(7); Lewicki M, Ng I, Schneider AG. HMG CoA reductase inhibitors (statins) for preventing acute kidney injury after surgical procedures requiring cardiac bypass. Cochrane Database of Systematic Reviews. 2015(3).
|Health Research Classification System category||Cardiovascular|
|Extra information provided by this PSP|
|Original uncertainty examples||Determine optimal perioperative management of cardiovascular medications (e.g. ACE-inhibitors, antiplatelet agents...); Should all patients receive dual antiplatelet agents post CABG if no contra-indications? ~ Is there an alternative to warfarin?|
|Submitted by||3 x patient, 12 x healthcare professional, 2 others|
|PSP unique ID||0088|
|PSP name||Heart Surgery|
|Total number of uncertainties identified by this PSP.||45 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)|
|Date of priority setting workshop||11 July 2019|