Pre-Cath Medications

This infographic provides essential guidance on managing medications before cardiac catheterization, focusing on balancing medication safety and procedure outcomes.

Metformin

• eGFR ≥ 60:
• Continue Metformin.
• Rationale: Lower risk of contrast-associated acute kidney injury (AKI).
• eGFR ≤ 45:
• Avoid Metformin.
• Rationale: Increased risk of lactic acidosis peri-cath, though the evidence remains weak.

Glucose-Lowering Medications (e.g., Insulin, Sulfonylureas)

• No history of hypoglycemia:
• Continue as usual.
• Rationale: NPO status can increase the risk of hypoglycemia, but some glucose-lowering agents can be safely continued.
• History of hypoglycemia:
• Hold or reduce the morning dose of these medications.
• Rationale: Sedation and fasting before the procedure heighten hypoglycemia risk.

RAAS Inhibitors (ACEi/ARB)

• eGFR ≥ 60:
• Continue these medications.
• Rationale: The risk of peri-procedure complications is low.
• eGFR < 60:
• Hold 24 hours pre-cath.
• Rationale: RAAS inhibition may reduce GFR, increasing the risk of contrast-induced AKI.

Oral Anticoagulants (OAC, e.g., Warfarin, DOACs)

• Thrombotic risk (e.g., AF, mechanical valve):
• Continue OAC, especially for radial access.
• Rationale: Good evidence supports continuing OAC unless there is high bleeding risk.
• Bleeding risk (e.g., rotational atherectomy, CTO):
• Hold Warfarin and bridge with LMWH if necessary.
• Rationale: Reducing bleeding risk is critical in high-risk procedures.

Created by: Dr. Hirsh Elhence

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