Guidelines

Perioperative cardiovascular evaluation and management of adult patients undergoing noncardiac surgery.

Population Adult patients undergoing noncardiac surgery

• Updated guidance on perioperative cardiovascular evaluation for noncardiac surgery, superseding the 2014 ACC/AHA guideline
• Evidence-based recommendations for pharmacological therapies in the perioperative setting
• Perioperative monitoring strategies for cardiovascular disease
• Management of devices in perioperative cardiovascular care
• Integration of evidence for associated medical conditions affecting perioperative risk

Evidence grading ACC/AHA

What's new Supersedes the 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery with updated evidence and expanded guidance on pharmacological therapies, monitoring, and device management.

AI-formatted from the abstract, confirm against the source.

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Glycemic management in noncritically ill hospitalized adult patients with diabetes, newly recognized hyperglycemia, or stress-induced hyperglycemia.

Population Adult patients with diabetes or newly recognized hyperglycemia in non-critical care hospital settings (>30% of noncritically ill hospitalized patients).

• Conditional recommendations made for hospital use of continuous glucose monitoring and insulin pump therapy in noncritically ill hospitalized patients with diabetes or hyperglycemia.
• Insulin regimens are recommended for management of prandial insulin dosing, glucocorticoid-associated hyperglycemia, and enteral nutrition-associated hyperglycemia in hospitalized patients.
• Conditional recommendations address appropriate use of correctional (rescue) insulin in the hospital setting.
• Noninsulin therapies may be considered for glycemic management in select hospitalized patients.
• Preoperative glycemic measures are recommended for noncritically ill patients undergoing surgery.
• A conditional recommendation is made against preoperative use of caloric beverages in patients with diabetes.
• Diabetes self-management education should be provided to hospitalized patients during inpatient stay.

Evidence grading GRADE

What's new Updated from 2012 guideline; now includes conditional recommendations for emerging diabetes technologies such as continuous glucose monitoring and insulin pump therapy in hospitalized patients, as well as expanded guidance on insulin regimens for prandial insulin dosing, glucocorticoid-associated hyperglycemia, and enteral nutrition-associated hyperglycemia.

AI-formatted from the abstract, confirm against the source.

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Clinical management of alcohol withdrawal syndrome across acute and post-acute care settings.

• Assess severity of alcohol withdrawal and risk of seizures and delirium tremens to guide intensity of monitoring and treatment
• Benzodiazepines are first-line pharmacotherapy for alcohol withdrawal
• Thiamine supplementation is recommended to prevent and treat wernicke encephalopathy
• Symptom-triggered dosing of benzodiazepines is preferred over fixed-schedule dosing when feasible
• Correction of electrolyte abnormalities, particularly magnesium and potassium, is essential in management
• Long-acting benzodiazepines such as chlordiazepoxide or diazepam are preferred over short-acting agents for withdrawal management

AI-formatted from the abstract, confirm against the source.

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Perioperative management of antithrombotic therapy for patients on long-term oral anticoagulants or antiplatelet drugs undergoing elective surgery or procedure, for clinicians managing patients receiving vitamin K antagonists, heparin bridging, direct oral anticoagulants, or antiplatelet drugs.

Population Patients receiving long-term oral anticoagulant or antiplatelet therapy requiring elective surgery or procedure

• Do not use heparin bridging in patients with atrial fibrillation (Strong recommendation)
• Continue VKA therapy in patients having pacemaker or internal cardiac defibrillator implantation (Strong recommendation)
• Separate recommendations apply for minor procedures including dental, dermatologic, ophthalmologic, pacemaker/internal cardiac defibrillator implantation, and endoscopic procedures
• Guideline addresses 44 total recommendations across four categories: vitamin K antagonists, heparin bridging, direct oral anticoagulants, and antiplatelet drugs

Evidence grading GRADE

What's new Substantial new evidence has emerged since the 2012 iteration, particularly to inform best practices for perioperative management of patients on vitamin K antagonists with heparin bridging, patients on direct oral anticoagulants, and patients on one or more antiplatelet drugs.

AI-formatted from the abstract, confirm against the source.

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Treatment of opioid use disorder for all patients.

Population Patients with opioid use disorder

• Medication-assisted treatment with methadone, buprenorphine, or naltrexone is recommended for opioid use disorder.
• Psychosocial support and counseling should be integrated with pharmacological treatment.
• Treatment should be individualized based on patient assessment and clinical presentation.
• Medication-assisted treatment improves treatment retention and reduces illicit opioid use.
• Regular monitoring and follow-up care are essential components of opioid use disorder treatment.

Evidence grading Not specified

AI-formatted from the abstract, confirm against the source.

Open the guideline on PubMed →

Perioperative cardiovascular evaluation and management of adult patients undergoing noncardiac surgery.

Population Adult patients undergoing noncardiac surgery

• Updated guidance on perioperative cardiovascular evaluation for noncardiac surgery, superseding the 2014 ACC/AHA guideline
• Evidence-based recommendations for pharmacological therapies in the perioperative setting
• Perioperative monitoring strategies for cardiovascular disease
• Management of devices in perioperative cardiovascular care
• Integration of evidence for associated medical conditions affecting perioperative risk

Evidence grading ACC/AHA

What's new Supersedes the 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery with updated evidence and expanded guidance on pharmacological therapies, monitoring, and device management.

AI-formatted from the abstract, confirm against the source.

Open the guideline on PubMed →

Perioperative management of antithrombotic therapy for patients on long-term oral anticoagulants or antiplatelet drugs undergoing elective surgery or procedure, for clinicians managing patients receiving vitamin K antagonists, heparin bridging, direct oral anticoagulants, or antiplatelet drugs.

Population Patients receiving long-term oral anticoagulant or antiplatelet therapy requiring elective surgery or procedure

• Do not use heparin bridging in patients with atrial fibrillation (Strong recommendation)
• Continue VKA therapy in patients having pacemaker or internal cardiac defibrillator implantation (Strong recommendation)
• Separate recommendations apply for minor procedures including dental, dermatologic, ophthalmologic, pacemaker/internal cardiac defibrillator implantation, and endoscopic procedures
• Guideline addresses 44 total recommendations across four categories: vitamin K antagonists, heparin bridging, direct oral anticoagulants, and antiplatelet drugs

Evidence grading GRADE

What's new Substantial new evidence has emerged since the 2012 iteration, particularly to inform best practices for perioperative management of patients on vitamin K antagonists with heparin bridging, patients on direct oral anticoagulants, and patients on one or more antiplatelet drugs.

AI-formatted from the abstract, confirm against the source.

Open the guideline on PubMed →

Clinical management of alcohol withdrawal syndrome across acute and post-acute care settings.

• Assess severity of alcohol withdrawal and risk of seizures and delirium tremens to guide intensity of monitoring and treatment
• Benzodiazepines are first-line pharmacotherapy for alcohol withdrawal
• Thiamine supplementation is recommended to prevent and treat wernicke encephalopathy
• Symptom-triggered dosing of benzodiazepines is preferred over fixed-schedule dosing when feasible
• Correction of electrolyte abnormalities, particularly magnesium and potassium, is essential in management
• Long-acting benzodiazepines such as chlordiazepoxide or diazepam are preferred over short-acting agents for withdrawal management

AI-formatted from the abstract, confirm against the source.

Open the guideline on PubMed →

Treatment of opioid use disorder for all patients.

Population Patients with opioid use disorder

• Medication-assisted treatment with methadone, buprenorphine, or naltrexone is recommended for opioid use disorder.
• Psychosocial support and counseling should be integrated with pharmacological treatment.
• Treatment should be individualized based on patient assessment and clinical presentation.
• Medication-assisted treatment improves treatment retention and reduces illicit opioid use.
• Regular monitoring and follow-up care are essential components of opioid use disorder treatment.

Evidence grading Not specified

AI-formatted from the abstract, confirm against the source.

Open the guideline on PubMed →

Glycemic management in noncritically ill hospitalized adult patients with diabetes, newly recognized hyperglycemia, or stress-induced hyperglycemia.

Population Adult patients with diabetes or newly recognized hyperglycemia in non-critical care hospital settings (>30% of noncritically ill hospitalized patients).

• Conditional recommendations made for hospital use of continuous glucose monitoring and insulin pump therapy in noncritically ill hospitalized patients with diabetes or hyperglycemia.
• Insulin regimens are recommended for management of prandial insulin dosing, glucocorticoid-associated hyperglycemia, and enteral nutrition-associated hyperglycemia in hospitalized patients.
• Conditional recommendations address appropriate use of correctional (rescue) insulin in the hospital setting.
• Noninsulin therapies may be considered for glycemic management in select hospitalized patients.
• Preoperative glycemic measures are recommended for noncritically ill patients undergoing surgery.
• A conditional recommendation is made against preoperative use of caloric beverages in patients with diabetes.
• Diabetes self-management education should be provided to hospitalized patients during inpatient stay.

Evidence grading GRADE

What's new Updated from 2012 guideline; now includes conditional recommendations for emerging diabetes technologies such as continuous glucose monitoring and insulin pump therapy in hospitalized patients, as well as expanded guidance on insulin regimens for prandial insulin dosing, glucocorticoid-associated hyperglycemia, and enteral nutrition-associated hyperglycemia.

AI-formatted from the abstract, confirm against the source.

Open the guideline (free full text) →