Buspirone Does Not Need to Be Stopped Before CABG Surgery
Buspirone (Buspar) does not require discontinuation before CABG surgery, as it is not an antiplatelet, anticoagulant, or other medication known to increase perioperative bleeding risk or interfere with cardiac surgery.
Why Buspirone Can Be Continued
Buspirone is an anxiolytic medication that works through serotonin receptor modulation and has no antiplatelet, anticoagulant, or hemodynamic effects that would necessitate preoperative discontinuation. The comprehensive guidelines for perioperative medication management in CABG patients do not include buspirone among medications requiring cessation 1.
Medications That DO Require Stopping Before CABG
The evidence-based guidelines clearly specify which medications must be discontinued preoperatively, and buspirone is notably absent from these lists:
Antiplatelet Agents (must be stopped):
- Clopidogrel: Discontinue ≥5 days before elective CABG 1
- Prasugrel: Discontinue ≥7 days before elective CABG 1
- Ticagrelor: Discontinue ≥3 days before elective CABG 1
- GP IIb/IIIa inhibitors: Discontinue 2-4 hours before surgery (eptifibatide/tirofiban) or 12 hours (abciximab) 1
Anticoagulants (timing varies):
- Enoxaparin: Discontinue 12-24 hours before CABG 1
- Fondaparinux: Discontinue 24 hours before CABG 1
- Bivalirudin: Discontinue 3 hours before CABG 1
- DOACs (rivaroxaban, apixaban, edoxaban, dabigatran): Discontinue 1-2 days before depending on renal function 1
Medications That Should Be CONTINUED:
- Aspirin: Continue until day of surgery and restart within 24 hours postoperatively 1
- Beta-blockers: Continue and administer for at least 24 hours before CABG 1, 2
- Statins: Continue perioperatively unless contraindicated 1, 3
- Unfractionated heparin: Continue until surgery 1, 4
Clinical Reasoning
The absence of buspirone from all major cardiac surgery guidelines reflects its pharmacologic profile. Unlike medications that affect coagulation, platelet function, or hemodynamics, buspirone poses no increased risk for:
- Perioperative bleeding 1
- Hemodynamic instability during anesthesia 5, 6
- Interference with surgical hemostasis 7
Important Caveat
While buspirone itself does not require discontinuation, anxiety management remains important in the perioperative period. Continuing buspirone may help maintain psychological stability during the stressful preoperative period. However, coordinate with the anesthesia team regarding all medications the patient is taking 1.