From the Guidelines
Yes, Losartan can be restarted after Coronary Artery Bypass Grafting (CABG), as long as the patient is stable and there are no contraindications.
Key Considerations
- According to the 2011 ACCF/AHA guideline for coronary artery bypass graft surgery 1, ACE inhibitors and ARBs given before CABG should be reinstituted postoperatively once the patient is stable, unless contraindicated.
- The 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery 1 also supports the continuation of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers perioperatively, and recommends restarting them as soon as clinically feasible postoperatively if they were held before surgery.
- Some key factors to consider when deciding to restart Losartan include:
- The patient's stability and absence of contraindications
- The presence of conditions such as hypertension, diabetes mellitus, or chronic kidney disease (CKD)
- The patient's left ventricular ejection fraction (LVEF)
Clinical Application
In clinical practice, Losartan can be restarted at the same dose the patient was taking preoperatively, as long as the patient is stable and there are no contraindications. It is essential to monitor the patient's blood pressure, renal function, and electrolyte levels after restarting Losartan. The decision to restart Losartan should be individualized based on the patient's specific clinical circumstances, and in accordance with the guidelines and recommendations from reputable sources, such as the American College of Cardiology and the American Heart Association 1.
From the Research
Losartan Restart After CABG
- There is no direct evidence in the provided studies regarding the restart of Losartan after Coronary Artery Bypass Grafting (CABG) 2, 3, 4, 5, 6.
- However, studies suggest that angiotensin-converting enzyme (ACE) inhibitors, which are similar to Losartan (an angiotensin II receptor antagonist), may not have a significant impact on mortality or recurrent ischemic events after CABG 3.
- The use of ACE inhibitors, statins, and β-blockers after CABG has been evaluated, with statins and β-blockers showing a significant improvement in event-free survival 3.
- Postoperative management of CABG patients involves careful consideration of various factors, including the use of medications such as statins, which have been shown to improve outcomes 6.
- The decision to restart Losartan after CABG would likely depend on individual patient factors, such as renal function, blood pressure, and overall clinical condition, rather than a blanket recommendation for all patients 2, 4, 5.