Postprocedural management of patients with cardiovascular disease

In this topic, the term ‘procedure’ refers to any operation or procedure.

All procedures cause a stress response in the body due to tissue injury. The stress response can increase myocardial oxygen demand and affect the balance of fibrinolytic and prothrombotic factors, increasing the risk of cardiac complications in the periprocedural period. Patients with cardiovascular disease, particularly unstable disease, are at further increased risk and require careful management to minimise morbidity and mortality.

Plan postprocedural venous thromboembolism prophylaxis if indicated; see Venous thromboembolism: prophylaxis for more information.

Cardiac conditions are usually managed with the patient’s standard therapy postprocedurally. Restart most drugs when oral fluids are tolerated. Drugs that can reduce blood pressure should be restarted cautiously to avoid symptomatic hypotension.

If oral dosing is not possible for an extended period, manage cardiac conditions with parenteral drugs. Transdermal glyceryl trinitrate patches can be useful for postprocedural elevated blood pressure, ischaemia or heart failure. Consider and manage treatable causes of postprocedural elevated blood pressure (eg pain, anxiety, hypothermia, hypoxaemia) before starting new blood pressure–lowering drugs. If urgent blood pressure reduction is needed postprocedurally, see General principles of the urgent control of elevated blood pressure for information, including defining features and management.

A patient’s blood pressure can remain low for days to weeks after the procedure; consider withholding usual blood pressure–lowering therapy in hospital and on discharge. The general practitioner or physician should decide if and at what dosage blood pressure–lowering therapy is re-introduced.

Avoid NSAIDs (including cyclo-oxygenase-2 [COX-2] inhibitors) for postprocedural pain in patients with heart failure (as they can cause fluid retention) or kidney impairment (which they can exacerbate).