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, the study by 2 suggests that the use of renin-angiotensin-aldosterone system (RAAS) inhibitors, which includes Losartan, is associated with lower mortality risk after CABG.
- The study by 6 discusses the use of antiplatelet therapy in patients undergoing CABG, but does not provide information on the restart of Losartan.
- It is essential to note that the decision to restart Losartan after CABG should be based on individual patient characteristics and medical history, and should be made in consultation with a healthcare professional.
Secondary Prevention Medications after CABG
- The study by 2 found that the use of secondary prevention medications, including RAAS inhibitors, after CABG is high early after surgery but decreases significantly over time.
- The study suggests that treatment with statins, RAAS inhibitors, and platelet inhibitors is essential after CABG, whereas the routine use of β-blockers may be questioned 2.
- The study by 6 provides recommendations for the use of antiplatelet therapy in patients undergoing CABG, but does not discuss the use of RAAS inhibitors like Losartan.
CABG Complications and Management
- The study by 5 provides an overview of the complications that can occur after CABG, including sternal wound infections, pneumonia, thromboembolic phenomena, and graft failure.
- The study emphasizes the importance of early surgical consultation and optimizing patient hemodynamics in the management of post-CABG complications 5.