Management of medications taken chronically and smoking before noncardiac surgery

ASA
Withhold at least 3 days before surgeryy and restart ASA when the risk of bleeding related to surgery has passed (ie, 8-10 days after major noncardiac surgery)

β-Blocker
Continue the β-blocker during the perioperative period; however, if a patient’s systolic blood pressure is low before surgery, physicians should consider decreasing or holding the dose of the β-blocker before surgery

ACEI/ARB
Withhold ACEI/ARB 24 hours before noncardiac surgery and restart ACEI/ARB on day 2 after surgery, if the patient is hemodynamically stable

Statin
Continue the statin during the perioperative period

Smoking
Discuss and facilitate smoking cessation (eg, nicotine replacement therapy), ideally starting ! 4 weeks before surgery