What are the recommendations for management of patients treated with oral and intravenous antiplatelet agents who undergo CABG?
The 2011 CABG Clinical Practice Guideline recommends that preoperative aspirin should be used to reduce operative morbidity and mortality, and CABG can be performed safely in patients on aspirin therapy with only a modest increase in bleeding risk. In addition, clopidogrel and ticagrelor should be discontinued at least 5 days before surgery and prasugrel at least 7 days before surgery in patients referred for elective CABG. However, in patients referred for urgent CABG, it may be reasonable to perform surgery less than 5 days after clopidogrel or ticagrelor has been discontinued and less than 7 days after prasugrel has been discontinued.