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Pre-Cath Medications

Pre-Cath Meds Infographic

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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