Do you hold Jardiance (Empagliflozin) for heart catheterization?

Management of Jardiance (Empagliflozin) for Heart Catheterization

Jardiance (empagliflozin) should be held on the day of heart catheterization to reduce the risk of adverse events, particularly in patients with renal impairment.

Rationale for Holding Jardiance

Empagliflozin (Jardiance) is an SGLT2 inhibitor that works by increasing urinary glucose excretion, which can affect fluid balance and potentially increase risks during cardiac catheterization procedures:

• While there are no specific guidelines directly addressing SGLT2 inhibitors before cardiac catheterization, several considerations support holding the medication:

1. Hemodynamic Effects:

   • Empagliflozin causes osmotic diuresis and may contribute to volume depletion 1
   • During cardiac catheterization, patients may already be at risk for hemodynamic instability

2. Renal Considerations:

   • Cardiac catheterization involves contrast media administration, which carries risk of contrast-induced nephropathy
   • The KDOQI guidelines recommend minimizing nephrotoxic agents before contrast administration 2
   • Combining the diuretic effect of empagliflozin with contrast exposure could potentially increase renal stress

3. Procedural Safety:

   • Cardiac catheterization is an invasive procedure requiring careful hemodynamic monitoring 2
   • Maintaining stable fluid status is important during the procedure

Timing Recommendations

• Pre-procedure: Hold Jardiance on the morning of the procedure
• Post-procedure: Resume Jardiance 24-48 hours after the procedure, once adequate hydration is confirmed and renal function is stable

Special Considerations

For Patients with Diabetes

• Blood glucose monitoring should be more frequent on the day of the procedure
• Alternative glycemic control methods may be needed temporarily
• The American Heart Association recommends adequate hydration before cardiac catheterization, especially in patients with chronic kidney disease 2

For Patients with Heart Failure

• Empagliflozin has demonstrated cardioprotective benefits in heart failure patients 3
• The temporary discontinuation for the procedure should not significantly impact these long-term benefits
• Resume as soon as safely possible after the procedure

Contrast Nephropathy Prevention

When performing cardiac catheterization in patients taking Jardiance:

• Ensure adequate hydration before and after contrast administration 2
• Calculate the contrast volume to creatinine clearance ratio to predict maximum safe contrast volume 2
• Minimize the volume of contrast media used during the procedure 2

Post-Procedure Management

• Monitor renal function before resuming Jardiance
• Resume Jardiance once hemostasis is adequate and renal function is stable
• For patients who received stents, follow appropriate antiplatelet therapy guidelines 4

Common Pitfalls to Avoid

1. Failing to hold Jardiance in patients with pre-existing renal impairment
2. Resuming Jardiance too soon after contrast exposure
3. Inadequate hydration before and after the procedure
4. Not monitoring for volume depletion signs in patients on SGLT2 inhibitors

By temporarily holding Jardiance for cardiac catheterization and ensuring adequate hydration, the risk of procedure-related complications can be minimized while maintaining the long-term benefits of this medication for patients with diabetes and/or heart failure.