Ezetimibe Does Not Need to Be Discontinued Before Surgery
Ezetimibe should be continued through the perioperative period for patients undergoing surgery. There is no evidence-based requirement to discontinue this medication before surgical procedures, and doing so may expose patients to unnecessary cardiovascular risk.
Rationale for Continuation
No Perioperative Contraindications
The FDA drug label for ezetimibe contains no warnings or precautions regarding perioperative use or surgical procedures 1. Unlike medications with withdrawal potential, bleeding risk, or anesthetic interactions, ezetimibe has no documented perioperative safety concerns.
Cardiovascular Risk of Discontinuation
Stopping lipid-lowering therapy in high-risk patients can have serious consequences:
- Patients undergoing vascular surgery benefit from continued lipid-lowering therapy, with research showing that combination therapy (statin plus ezetimibe) reduces cardiovascular events in the 12 months following vascular surgery 2
- Early discontinuation of lipid therapy after acute coronary events increases MACE risk—delayed or absent ezetimibe use after MI is associated with higher rates of death, MI, and stroke 3
- The principle of maintaining cardiovascular medications perioperatively applies unless specific contraindications exist 4
Guideline Context
While the 2022 ACC guidelines discuss discontinuing lipid-lowering drugs in the context of pregnancy (recommending discontinuation 1-3 months before conception) 5, this is entirely unrelated to surgical procedures. No major cardiovascular guidelines recommend perioperative discontinuation of ezetimibe for surgery.
Practical Approach
Continue ezetimibe through surgery in all patients, particularly those with:
- Established atherosclerotic cardiovascular disease
- Recent acute coronary syndrome
- Planned vascular surgery
- Very high cardiovascular risk
The only scenario requiring ezetimibe discontinuation is pregnancy recognition, where it should be stopped unless benefits clearly outweigh fetal risks 5, 1.
Common Pitfalls to Avoid
- Do not confuse pregnancy-related discontinuation guidance with perioperative management—these are completely separate clinical contexts
- Do not apply statin perioperative concerns to ezetimibe—ezetimibe has no muscle toxicity or rhabdomyolysis risk that would be exacerbated by surgery
- Avoid unnecessary medication interruptions—discontinuing effective cardiovascular therapy without evidence-based indication increases patient risk