Risk of perioperative discontinuation of SGLT2 inhibitors

Maartina J.P. Oosterom-Eijmael; Jeroen Hermanides; Daniel H. van Raalte; Abraham H. Hulst

doi:10.1016/j.bja.2024.05.004

Risk of perioperative discontinuation of SGLT2 inhibitors

Maartina J.P. Oosterom-Eijmael
, Jeroen Hermanides^*
, Daniel H. van Raalte
, Abraham H. Hulst

^*Corresponding author for this work

Amsterdam UMC
Amsterdam UMC - University of Amsterdam
Department of Anesthesiology
Department of Endocrinology and Metabolism
Department of Vascular Medicine

Research output: Contribution to journal › Editorial › Academic › peer-review

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Abstract

When sodium-glucose cotransporter-2 (SGLT2) inhibitors were primarily prescribed for treatment of diabetes mellitus, guidelines recommended withholding SGLT2 inhibitors before surgery to mitigate the associated risk of ketoacidosis. However, currently, SGLT2 inhibitors are an established therapy for patients with heart failure, and there is evidence that withholding SGLT2 inhibitors can worsen these patients' cardiovascular risk profile. We present an updated risk-benefit analysis of withholding SGLT2 inhibitors before surgery, focusing on patients with heart failure and addressing the risk of ketoacidosis and its treatment in these patients. Clinicians should consider perioperative continuation of SGLT2 inhibitors when prescribed for treatment of heart failure.

Original language	English
Pages (from-to)	239-240
Number of pages	2
Journal	British journal of anaesthesia
Volume	133
Issue number	2
DOIs	https://doi.org/10.1016/j.bja.2024.05.004
Publication status	Published - Aug 2024

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

adverse events
euglycaemic ketoacidosis
heart failure
perioperative outcome
SGLT2 inhibitor

Access to Document

10.1016/j.bja.2024.05.004

Risk-of-perioperative-discontinuation-of-sglt2-inhibitors.pdfFinal published version, 147 KBLicence: CC BY

Cite this

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title = "Risk of perioperative discontinuation of SGLT2 inhibitors",

abstract = "When sodium-glucose cotransporter-2 (SGLT2) inhibitors were primarily prescribed for treatment of diabetes mellitus, guidelines recommended withholding SGLT2 inhibitors before surgery to mitigate the associated risk of ketoacidosis. However, currently, SGLT2 inhibitors are an established therapy for patients with heart failure, and there is evidence that withholding SGLT2 inhibitors can worsen these patients' cardiovascular risk profile. We present an updated risk-benefit analysis of withholding SGLT2 inhibitors before surgery, focusing on patients with heart failure and addressing the risk of ketoacidosis and its treatment in these patients. Clinicians should consider perioperative continuation of SGLT2 inhibitors when prescribed for treatment of heart failure.",

keywords = "adverse events, euglycaemic ketoacidosis, heart failure, perioperative outcome, SGLT2 inhibitor",

author = "Oosterom-Eijmael, \{Maartina J.P.\} and Jeroen Hermanides and \{van Raalte\}, \{Daniel H.\} and Hulst, \{Abraham H.\}",

note = "Publisher Copyright: {\textcopyright} 2024 British Journal of Anaesthesia",

year = "2024",

month = aug,

doi = "10.1016/j.bja.2024.05.004",

language = "English",

volume = "133",

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journal = "British journal of anaesthesia",

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T1 - Risk of perioperative discontinuation of SGLT2 inhibitors

AU - Oosterom-Eijmael, Maartina J.P.

AU - Hermanides, Jeroen

AU - van Raalte, Daniel H.

AU - Hulst, Abraham H.

PY - 2024/8

Y1 - 2024/8

N2 - When sodium-glucose cotransporter-2 (SGLT2) inhibitors were primarily prescribed for treatment of diabetes mellitus, guidelines recommended withholding SGLT2 inhibitors before surgery to mitigate the associated risk of ketoacidosis. However, currently, SGLT2 inhibitors are an established therapy for patients with heart failure, and there is evidence that withholding SGLT2 inhibitors can worsen these patients' cardiovascular risk profile. We present an updated risk-benefit analysis of withholding SGLT2 inhibitors before surgery, focusing on patients with heart failure and addressing the risk of ketoacidosis and its treatment in these patients. Clinicians should consider perioperative continuation of SGLT2 inhibitors when prescribed for treatment of heart failure.

AB - When sodium-glucose cotransporter-2 (SGLT2) inhibitors were primarily prescribed for treatment of diabetes mellitus, guidelines recommended withholding SGLT2 inhibitors before surgery to mitigate the associated risk of ketoacidosis. However, currently, SGLT2 inhibitors are an established therapy for patients with heart failure, and there is evidence that withholding SGLT2 inhibitors can worsen these patients' cardiovascular risk profile. We present an updated risk-benefit analysis of withholding SGLT2 inhibitors before surgery, focusing on patients with heart failure and addressing the risk of ketoacidosis and its treatment in these patients. Clinicians should consider perioperative continuation of SGLT2 inhibitors when prescribed for treatment of heart failure.

KW - adverse events

KW - euglycaemic ketoacidosis

KW - heart failure

KW - perioperative outcome

KW - SGLT2 inhibitor

UR - https://www.scopus.com/pages/publications/85195022473

U2 - 10.1016/j.bja.2024.05.004

DO - 10.1016/j.bja.2024.05.004

M3 - Editorial

C2 - 38834489

AN - SCOPUS:85195022473

SN - 0007-0912

VL - 133

SP - 239

EP - 240

JO - British journal of anaesthesia

JF - British journal of anaesthesia

IS - 2

ER -

Risk of perioperative discontinuation of SGLT2 inhibitors

Abstract

UN SDGs

Keywords

Access to Document

Other files and links

Fingerprint

MERCURI: proMoting Effective Renoprotection in Cardiac sURgery patients by Inhibition of SGLT-2

Safety, Risks, Harms and Effects of SGLT2 inhibitors in Perioperative Care

Change to perioperative protocols

Cite this

Risk of perioperative discontinuation of SGLT2 inhibitors

Abstract

UN SDGs

Keywords

Access to Document

Other files and links

Fingerprint

Projects

MERCURI: proMoting Effective Renoprotection in Cardiac sURgery patients by Inhibition of SGLT-2

Activities

Safety, Risks, Harms and Effects of SGLT2 inhibitors in Perioperative Care

Impacts

Change to perioperative protocols

Cite this