From the Guidelines
SGLT2 inhibitors can be given to patients who have undergone coronary artery bypass grafting (CABG), but it is recommended to temporarily discontinue them before planned surgery and restart once the patient is stable. The timing of discontinuation and restart is crucial, with guidelines suggesting that SGLT2 inhibitors such as empagliflozin, dapagliflozin, and canagliflozin should be stopped ≥3 days prior to scheduled surgery, including CABG, and ertugliflozin ≥4 days prior to surgery 1. This recommendation is based on the risk of diabetic and euglycemic ketoacidosis in the perioperative period, as well as the potential for hypovolemia and acute kidney injury 1. However, the cardiovascular benefits of SGLT2 inhibitors, including reduced risk of heart failure hospitalizations and major adverse cardiovascular events, make them a valuable treatment option for patients with established cardiovascular disease, such as those requiring CABG 1. Key considerations for the use of SGLT2 inhibitors in patients with CABG include:
- Temporary discontinuation before planned surgery to minimize perioperative risks
- Restarting the medication once the patient is stable, eating normally, and has normal kidney function post-surgery
- Regular monitoring of renal function after restarting the medication
- Weighing the potential benefits of SGLT2 inhibitors against the risks in individual patients.
From the Research
SGLT2 Inhibitors and CABG
- There is no direct evidence in the provided studies that discusses the use of SGLT2 inhibitors with Coronary Artery Bypass Graft (CABG) surgery 2, 3, 4, 5.
- The studies focus on the efficacy and safety of SGLT2 inhibitors in patients with type 2 diabetes, their mechanism of action, and their benefits in reducing blood glucose levels, body weight, and blood pressure 2, 3, 4, 5.
- One study discusses contemporary CABG surgery and subsequent percutaneous revascularization, but it does not mention the use of SGLT2 inhibitors in this context 6.
Potential Considerations
- SGLT2 inhibitors have been shown to have cardiovascular benefits, including reducing the risk of cardiovascular mortality and hospitalization for heart failure 2, 3, 4.
- However, the use of SGLT2 inhibitors in patients with a history of CABG surgery is not explicitly discussed in the provided studies.
- Clinicians should exercise caution when using SGLT2 inhibitors in patients with a history of cardiovascular disease, including those who have undergone CABG surgery, and carefully monitor their patients for potential adverse effects 3, 4.