Common Cardiac Surgery Medications

OHT: orthotopic heart transplant

TAVR: transcatheter aortic valve replacement

Mechanical Valve(s): INR goal 2.5 - 3.5

Bioprosthetic Valve(s): coumadin not typically started in ICU; see chart below

CentriMag: no specific antiplatelet therapy is required (unless required for concomitant disease states)

HMII: not routinely started. Monitor platelet aggregation studies (light transmittance aggregometry and PFA 100) in stable patients no sooner than 14 days post-device implantation (if arachidonic acid activity >50% begin aspirin 81mg three times per week (monday, wednesday, friday)

TAH: start on POD1 and onward if platelets >50,000 and chest tube output <30mL/hr for 4 consecutive hours. Monitor platelet aggregation studies (light transmittance aggregometry and PFA 100) in stable patients no sooner than 14 days post-device implantation; maintain arachiodonic acid activity <50%

Impella: no specific antiplatelet therapy is required (unless required for concomitant disease states)

 

General Rules

Aspirin

  • given within the first 24 hours

 

Beta-Blockers (once off pressors for several hours)

  • metoprolol succinate (sustain release, slow) 

  • metoprolol tartrate (twice per day)

  • carvedilol (coreg)

  • labetalol

 

Atorvastatin

  • 20, 40, or 80mg PO at bedtime

ENTRESTO (sacubitril/valsartan)

  • PARADIGM-HF trial

  • ARNI (angiotensin receptor-neprilysin inhibitor); neprilysin

  • becareful to use in patient with history of angioedema

  • angiotensin II receptor blocker indicated for the treatment of chronic heart failure

  • only medicine to show significant mortality benefit compared to Enalapril

  • angiotensin receptor neprilysin inhibitor (ARNI) that reduces strain on the failing heart. It contains two active components known as sacubitril, a neprilysin inhibitor, and valsartan, an angiotensin receptor blocker

  • inhibits neprilysin and blocks angiotensin II type-I receptor. It increases the levels of peptides that are degraded by neprilysin.

  • Valsartan inhibits the effects of angiotensin II by blocking the AT1 receptor and by inhibiting the release of angiotensin II-dependent aldosterone

  • follow BNP and proBNP

... but I would more especially commend the clinician who, in acute diseases, by which the bulk of mankind are cutoff, conducts the treatment better than others.
 
Hippocrates, 400 BC