ECG should be requested for patients who have angina or coronary event history in last 2 months, arrhythmia history, diabetes mellitus (DM) for asymptomatic patients older than 45 for males and 55 for females who have two and more risk factors. Nevertheless, ECG should not be ordered routinely for asymptomatic patients who do not fit these criteria.

It can be obtained in patients with decompensated congestive heart failure symptoms and in case of detected murmur and prior CHF (congestive heart failure) history. Otherwise, routine echocardiography request is class 3 [8].

Exercise stress test can be obtained in case of coronary artery disease or revascularization history in presence of angina complaints and it can be obtained in moderate or high-risk patients whose basal ECG is normal. Myocardial perfusion scintigraphy can be ordered for the patients with left bundle branch block, poor effort capacity and respiratory diseases.

Electively planned operation should be postponed for patients who show high risk at stress test, whose angina continues despite the medical treatment and who has high risk for coronary artery disease, and coronary angiography should be proposed.

Aspirin therapy is generally discontinued in perioperative period since it is considered to increase haemorrhagic complications. A large-scale meta-analysis of 41 studies comparing the bleeding risks of continuation to discontinuation of aspirin in perioperative period was conducted in 49,590 patients. As a result of this analysis, it is determined that risk of bleeding complication increased 1.5 times but aspirin did not cause more severe bleeding complications [9]. Systematical analysis of patients at risk and patients who have ischaemic heart disease demonstrated three times more increase in risk of major adverse cardiac event with discontinuation of aspirin therapy (odds ratio (OR) = 3,14, %95 confidence interval (CI) 1,8-5,6). Aspirin therapy should be discontinued only if bleeding risk is more than the cardiac benefit. Before minor surgical or endoscopic procedures, a careful evaluation about discontinuation of antithrombotic medications should be carried out. Principally, when individual risk and benefit assessment is taken into consideration, patients who get antiplatelet therapy do not have to stop their medication before aforementioned interventions. Platelet transfusion or use of other prohemostatic medications is recommended for patients who receive antiplatelet therapy such as Acetylsalicylic acid, Ticlopidine, Clopidogrel; for Prasugrel or Ticagrelor users and patients who have excessive or life-threatening perioperative bleeding. The decision-making on discontinuing antiplatelet therapy or not is hardest for the patient group who had previous cardiac revascularization procedure and received dual antiplatelet therapy. In percutaneous revascularization-applied patients, one of the antiplatelet therapies is stopped and treatment continues with acetylsalicylic acid ideally after 3 months and 12 months for bare metal stent-inserted ones and drug-eluting stent-inserted ones, respectively. It is suggested that the elective procedures should be postponed within these periods and performed afterwards under acetylsalicylic acid therapy [10, 11].