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- FIGURE 1
Canadian guidelines on preoperative risk assessment and postoperative monitoring.
Tables
Type of coronary intervention Delay for nonurgent surgery Angioplasty without stenting 14 days2 Bare-metal stent 30 days16 Drug-eluting stent Optimal: 6 months16
3–6 months if benefits of surgery outweigh risks of stent thrombosis16From references 2 and 16.
Snoring: Do you snore loudly (loud enough to be heard through closed doors)? Tired: Do you often feel tired, fatigued, or sleepy during daytime? Observed: Has anyone observed you stop breathing during your sleep? Blood Pressure: Do you have or are you being treated for high blood pressure? BMI more than 35 kg/m2? Age older than 50? Neck circumference > 40 cm (16 in)? Gender male? Low risk of obstructive sleep apnea: Yes to 0–2 questions
High risk: Yes to 3 or more questions
From Chung F, Yegneswaran B, Liao P, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology 2008; 108:812–821, anesthesiology.pubs.asahq.org/journal.aspx.
- TABLE 3
American College of Cardiology recommendations: Perioperative anticoagulation in patients with atrial fibrillation
Thromboembolic risk category Bleeding risk category Recommendation Low
(≤5%/year, CHA2DSr-VASc ≤ 4)aAll levels of bleeding Interrupt vitamin K antagonists without bridging Moderate
(5%-10%/year, CHA2DS2-VASc 5 or 6)High procedural bleeding risk Interrupt vitamin K antagonists without bridging No significant bleeding risk without history of stroke, transient ischemic attack, or systemic embolism Interrupt vitamin K antagonists without bridging No significant bleeding risk with history of stroke, transient ischemic attack, or systemic embolism Consider bridging High
(> 10%/year, CHA2DS2-VASC≥7)All levels of bleeding risk Should generally be considered for bridging High bleeding risk Apply clinical judgment ↵a CHA2DS2-VASc = 1 point for congestive heart failure, hypertension, age 65 to 75, diabetes, vascular disease, or female sex; 2 points for history of either stroke or transient ischemic attack or thromboembolism, and/or age ≥ 75.
Based on information in reference 25.
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- Article
- ABSTRACT
- HOW TO SCREEN FOR CARDIAC RISK BEFORE NONCARDIAC SURGERY
- WHAT IS THE APPROPRIATE TIMING FOR SURGERY AFTER PCI?
- CAN WE USE STATINS TO REDUCE PERIOPERATIVE RISK?
- HOW SHOULD WE MANAGE SLEEP APNEA RISK PERIOPERATIVELY?
- WHICH ATRIAL FIBRILLATION PATIENTS NEED BRIDGING ANTICOAGULATION?
- IS FRAILTY SCREENING BENEFICIAL BEFORE NONCARDIAC SURGERY?
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