Pre-op risk
How the 2026 AHA/ACC guideline for perioperative cardiovascular management approaches risk before noncardiac surgery, taught step by step. The 2026 edition reaffirms the 2024 guideline with no changes .
This is what the guideline says, not an order for a patient. Agents and doses follow local protocols and the treating team.
Step 1
Which drug classes does the patient take?
Tap all that apply. The guideline’s advice for each class appears below.
Step 2
What the guideline says
Pick at least one class above to see what the guideline says about it.
Step 3 is inside each card: open Timing details and facts for the tables and schedules, each with its citation.
Medicines with no class on this page
From the maintainers’ reading of the guideline, not a statement in it.
The guideline gives no perioperative continue-or-hold advice for: diuretics, nitrates, antiarrhythmics, digoxin, ranolazine. Digoxin, antiarrhythmic drugs and nitrates are mentioned only in other contexts (heart-rate control in severe mitral stenosis, postoperative atrial fibrillation, perioperative non-ST-elevation myocardial infarction).
It states few doses. Trial regimens are described as trial regimens, not as recommendations, and no dose was added from outside the guideline.
Abbreviations used on this page
- COR
- Class of Recommendation (1 recommended, 2a reasonable, 2b may be considered, 3 not recommended)
- LOE
- Level of Evidence
- DAPT
- dual antiplatelet therapy (aspirin plus a P2Y12 inhibitor)
- PCI
- percutaneous coronary intervention (a stent or balloon angioplasty)
- DES / BMS
- drug-eluting stent / bare-metal stent
- ACS / CCD
- acute coronary syndrome / chronic coronary disease
- NCS
- noncardiac surgery
- OAC / DOAC
- oral anticoagulant / direct oral anticoagulant
- LMWH
- low-molecular-weight heparin
- VTE / AF
- venous thromboembolism / atrial fibrillation
- MACE
- major adverse cardiovascular events
- RAAS / ACE / ARB
- renin-angiotensin-aldosterone system / angiotensin-converting enzyme inhibitor / angiotensin receptor blocker
- HFrEF
- heart failure with reduced ejection fraction
- SGLT2
- sodium-glucose cotransporter 2
- GLP-1
- glucagon-like peptide 1
- CrCl
- creatinine clearance
29 recommendations in 14 drug classes, from Sections 7 and 8.4 of the guideline.