Is it safe to use Eligard (leuprolide) in the preoperative period for Coronary Artery Bypass Grafting (CABG) in patients with prostate cancer?

From the Guidelines

Eligard (leuprolide) can be safely continued during the preoperative period for Coronary Artery Bypass Grafting (CABG) in patients with prostate cancer, as it does not increase bleeding risk or interfere with anesthesia. The medication is a gonadotropin-releasing hormone (GnRH) agonist that works by suppressing testosterone production, which is crucial for ongoing prostate cancer management 1.

Key Considerations

• The medication is administered as a depot injection (typically 7.5 mg monthly, 22.5 mg every 3 months, 30 mg every 4 months, or 45 mg every 6 months) and maintains consistent hormone suppression throughout the perioperative period.
• Patients should inform their surgical team about this medication during preoperative evaluation, but no dose adjustments are typically needed.
• The cardiovascular effects of androgen deprivation therapy should be considered in the overall surgical risk assessment, as long-term use of GnRH agonists may be associated with certain cardiovascular risk factors, though this doesn't typically impact acute surgical management 1.

Coordination of Care

• Coordination between the urologist managing the prostate cancer and the cardiac surgical team is advisable to ensure optimal care.
• It is essential to consider the patient's individual risk factors and overall health status when making decisions about continuing or discontinuing Eligard during the preoperative period.

Perioperative Management

• The American College of Chest Physicians clinical practice guideline suggests continuation of ASA over interruption in patients undergoing CABG surgery, and interruption of the P2Y12 inhibitor over continuation perioperatively 1.
• Resuming ASA or the P2Y12 inhibitor within 24 hours after surgery is recommended compared to delaying resumption for 24 hours or more 1.

From the Research

Safety of Eligard in Preoperative Period for CABG

• The safety of using Eligard (leuprolide) in the preoperative period for Coronary Artery Bypass Grafting (CABG) in patients with prostate cancer is not directly addressed in the provided studies 2, 3, 4, 5, 6.
• However, the studies provide information on the effects of leuprolide on the body, which can be relevant to the preoperative period for CABG.
• Leuprolide is a gonadotropin-releasing hormone (GnRH) agonist that suppresses testicular androgen production, which can lead to changes in metabolism and body composition 4, 6.
• One study found that GnRH agonists, such as leuprolide, can increase fat mass, decrease insulin sensitivity, and increase triglycerides, which may be relevant to the preoperative period for CABG 6.
• Another study found that preoperative exposure to certain medications, such as clopidogrel, can increase the risk of mortality and morbidity in patients undergoing CABG, highlighting the importance of careful medication management in the preoperative period 5.

Potential Risks and Considerations

• The use of leuprolide in the preoperative period for CABG may be associated with changes in metabolism and body composition, which can increase the risk of complications during surgery 6.
• The potential risks and benefits of using leuprolide in the preoperative period for CABG should be carefully considered, taking into account the individual patient's medical history and condition 2, 3, 4.
• Further studies are needed to fully understand the safety and efficacy of using leuprolide in the preoperative period for CABG in patients with prostate cancer.