Which medications should generally be held prior to cardiac surgery to reduce the risk of post-operative bleeding?

Holding certain medications prior to cardiac surgery is essential to minimizing the risk of post-operative bleeding. Non-steroidal anti-inflammatory drugs (NSAIDs) and antiplatelet agents like clopidogrel are particularly important to withhold because they can significantly affect platelet function and coagulation pathways. Clopidogrel, as an antiplatelet medication, can prolong bleeding time by inhibiting platelet aggregation, making it critical to stop before any surgical procedure involving the heart.

ACE inhibitors may also contribute to hypotension during surgery, which can complicate care, although their direct effect on bleeding is less pronounced. However, their involvement in blood pressure regulation makes them candidates for consideration in pre-operative medication management.

The inclusion of oral hypoglycemic agents in the decision to hold medications relates more to potential surgical stress responses and blood glucose management rather than directly influencing bleeding risk, but they are often considered in the preoperative setting for overall safety.

By holding these medications, especially antiplatelet agents and NSAIDs, surgeons aim to optimize hemostasis and reduce the risk of excessive bleeding during and after the surgical procedure, ensuring better outcomes for the patient post-operatively. The combination of Clopidogrel, ACE inhibitors, oral hypoglycemic agents, and